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AnteayerNursing Research

Organizational Support for Nurse Practitioners in Primary Care and Workforce Outcomes

imageBackground Lack of organizational support in healthcare settings has been linked to high levels of clinician stress, burnout, and job dissatisfaction. Little research exists on organizational support for nurse practitioners. Objective We investigated the relationship between organizational support and nurse practitioner outcomes, including job satisfaction, intent to leave, and quality of care. Methods A cross-sectional survey design was used to collect survey data from nurse practitioners (n = 398) in primary care practices in New York State in 2017. Nurse practitioners completed mail surveys with validated measures of organizational support, job satisfaction, intent to leave, and quality of care. Information on participant demographics and work characteristics was also collected. Multilevel regression models assessed the relationship between organizational-level organizational support and resources measure and job satisfaction, intent to leave, and quality of care. Results The organizational-level organizational support and resources measure had a mean of 3.31 on a 4-point scale. Twenty-five percent of the participants were either moderately dissatisfied or very dissatisfied with their jobs, and about 11% intended to leave their current jobs within 1 year. The average quality of care rated by participants was 8.51 out of 10—10 being the best quality of care. After adjusting for covariates, higher organizational-level organizational support and resources measure score was associated with higher job satisfaction category, lower odds of intent to leave, and higher quality of care. Discussion Nurse practitioners from primary care practices with higher levels of organizational support are more likely to be satisfied with their jobs, have less intent to leave their jobs, and report better quality of care. Thus, in order to promote nurse practitioner job satisfaction, retain them in clinical positions, and improve quality of care, administrators should take actions to promote organizational support for them. Our findings are consistent with existing literature regarding the relationship between organizational support and clinician outcomes.

Development and Psychometric Analysis of the Patient Preferences for Engagement Tool

imageBackground Assessing patients’ preferences for engaging in healthcare is needed to inform the planning and delivery of individualized healthcare. Unfortunately, patients are often not engaged in their care to the extent that they would like, leading to patient feelings of disempowerment and frustration. Objectives The purpose of this study was to (a) develop and (b) psychometrically test the Patient Preferences for Engagement Tool (PPET), a clinical assessment tool that can be used by nursing staff to identify patient preferences for engagement in healthcare. The usability of the PPET was also examined for both nurses and patients participating in the study. Methods The psychometric evaluation design used content and construct validity testing (exploratory and confirmatory factor analysis, known groups comparisons) and reliability estimation using Cronbach’s alpha coefficient. The sample consisted of 308 adult patients aged 18–101 years from a Midwestern U.S. Magnet-designated academic medical center. Results Content validity index was at least 0.8 for all but one item. Using a split sample, a six-factor solution was first identified using exploratory factor analysis and then confirmed using confirmatory factor analysis. Demographic and illness factors were not significant predictors of factor scores. Cronbach’s alpha coefficients of all six factors were >0.7. Both patients and nurses gave high ratings to the tool on effectiveness, efficiency, and satisfaction with use. Discussion The PPET demonstrated acceptable validity and reliability estimates. Assessing patient preferences for engagement gives value to the patient voice and provides an opportunity to have discussions with patients about various ways they can engage in their healthcare. Future research will focus on reducing the number of items on the PPET to construct a clinically useful resource for providers to use to assess patient preferences for healthcare engagement, leading to the development of more personalized care delivery methods.

How Nurse Scientists Can Stay Productive and on Track During the Pandemic

Por: Bruner · Deborah W.
imageOn March 11, 2020, with the declaration of a global pandemic by the World Health Organization, an unplanned slowdown of academic research activities has taken place. Although this is not an ideal situation for nurse scientists, it presents a number of unique opportunities for researchers to shift their focus in the short term, which may actually lead to more productivity in the long term. This commentary explores ways nurse scientists can stay on track without derailing their plans for career advancement under unprecedented circumstances.

Application of Behavioral Risk Factor Surveillance System Sampling Weights to Transgender Health Measurement

imageBackground Obtaining representative data from the transgender population is fundamental to improving their health and well-being and advancing transgender health research. The addition of the Behavioral Risk Factor Surveillance System (BRFSS) gender identity measure is a promising step toward better understanding transgender health. However, methodological concerns have emerged regarding the validity of data collected from transgender participants and its effect on the accuracy of population parameters derived from those data. Objectives The aim of the study was to provide rationale substantiating concerns with the formulation and application of the 2015 BRFSS sampling weights and address the methodological challenges that arise when using this surveillance data to study transgender population health. Methods We examined the 2015 BRFSS methodology and used the BRFSS data to present a comparison of poor health status using two methodological approaches (a matched-subject design and the full BRFSS sample with sampling weights applied) to compare their effects on parameter estimates. Results Measurement error engendered by BRFSS data collection procedures introduced sex/gender identity discordance and contributed to problematic sampling weights. The sex-specific “raking” algorithm used by BRFSS to calculate the sampling weights was contingent on the classification accuracy of transgender by participants. Because of the sex/gender identity discordance of 74% of the transgender women and 66% of transgender men, sampling weights may not be able to adequately remove bias. The application of sampling weights has the potential to result in inaccurate parameter estimates when evaluating factors that may influence transgender health. Discussion Generalizations made from the weighted analysis may obscure the need for healthcare policy and clinical interventions aimed to promote health and prevent illness for transgender adults. Methods of public health surveillance and population surveys should be reviewed to help reduce systematic bias and increase the validity of data collected from transgender people.

Symptom Profiles of Latina Breast Cancer Survivors: A Latent Class Analysis

imageBackground Symptom research among Latinas with breast cancer is limited—especially as it relates to multiple co-occurring symptoms. Objective The aim of the study was to identify subgroups (latent classes) of Latinas who have distinct symptom profiles while receiving radiation, chemotherapy, and/or hormonal therapy for breast cancer. Methods This secondary analysis included intake data from three randomized trials of supportive care psychosocial interventions for Latinas treated for breast cancer (n = 290). Prevalence of 12 symptoms—measured using the General Symptom Distress Scale—was entered into the latent class analysis to identify classes of women with different symptom profiles. Results Most of the participants had Stage II or III disease, and 81% reported receiving chemotherapy. On average, women reported 4.2 (standard deviation [SD] = 3) symptoms with an overall symptom distress score of 6.4 (SD = 2.5) on a 1–10 scale, with 10 being most distressing. Latent class analysis resulted in three classes that were labeled based on symptoms with the highest prevalence. Class 1 (n = 192) was “Disrupted Sleep and Tired,” Class 2 (n = 74) was “Tired,” and Class 3 (n = 24) was “Pain, Disrupted Sleep, and Tired.” Depression, anxiety, and difficulty concentrating had moderate prevalence in each of the three classes. Discussion Beyond the core six symptoms (depression, anxiety, fatigue, pain, disrupted sleep, difficulty concentration), the classes differed in the prevalence of other burdensome symptoms (e.g., nausea, vomiting, constipation), which provide implications for treatment. Thus, it is important to assess for the full range of symptoms so that supportive care interventions can be tailored for the distinct symptom profiles of Latinas with breast cancer.

Development of the Adverse Analgesic Drug Event Measure

imageBackground Little is known about how people respond to an analgesic adverse drug event despite the significant incidence of deaths and hospitalizations associated with analgesic adverse drug events. Objective The purpose of this two-phase instrument development study was to test the validity and reliability of the Analgesic Adverse Drug Event Measure (AADEM). Methods Content validity was established during Phase I. Six experts rated the 58-item measure developed from a pilot survey of adults who had experienced an analgesic adverse drug event. Experts’ ratings supported a 17-item AADEM with a scale content validity index of .86. Phase II consisted of online administration of the AADEM to a national Qualtrics panel who reported an adverse drug event from a self-administered analgesic. Exploratory factor analysis was conducted using principal axis factoring and oblique rotation including Direct Oblimin and Promax rotations with Kaiser normalization. Results Four factors emerged from the analysis: sought care, consulted provider, discontinued or continued analgesic, and attributed adverse drug event with a total explained variance of 55.4%. Scale content validity index for the 13-item AADEM was .88. Internal consistency for the four subscales was acceptable, but low for the full 13-item AADEM. Discussion Results establish preliminary evidence for the validity and reliability of the 13-item AADEM to measure response to an analgesic adverse drug event. Next steps involve confirmatory factor analysis in a different sample to examine the underlying construct of the AADEM. The AADEM might help identify people at risk for serious analgesic adverse drug events.

Protocol to Measure Hair Cortisol in Low Mass Samples From Very Preterm Infants

imageBackground Hair cortisol is a measure of chronic or repeated hypothalamic–pituitary–adrenal axis activation in response to physical or psychological stressors. Hair cortisol has been successfully used as a measure of chronic stress in adults and children; however, its use as a valid measure in preterm infants has been limited by challenges in measuring cortisol in the low mass samples collectable from these infants. Objectives The purpose of this report is to present a novel protocol for the measurement of hair cortisol in very low mass hair samples. Methods Small changes were made to previously published protocols. After washing and pulverizing the hair samples, a double methanol cortisol extraction was performed. Samples were spiked with a known quantity of cortisol and analyzed in duplicate using an enzyme-linked immunosorbent assay. Results Hair cortisol was detectable in samples weighing between 0.4 and 10.9 mg. The mean cortisol level was 23.74 pg/mg hair (SD = 26.38). Discussion With small changes to previously published laboratory protocols, cortisol is quantifiable in low mass hair samples from preterm infants. This technical advance is an important step toward quantifying the stress experiences of hospitalized preterm infants.

Sleep Quality Associated With Motor Function Among Older Adult Survivors of Critical Illness

imageBackground Poor sleep is associated with worse motor function in older adults. Sleep may affect motor function specifically among older adults recovering from critical illness after transfer out of an intensive care unit (ICU). Objectives Describe motor function (grip strength) of older ICU survivors and explore relationships between sleep and ICU-acquired weakness in the early post-ICU transition period. Methods We enrolled 30 older adults who were functionally independent prior to hospitalization, mechanically ventilated while in ICU, and within 24–48 hours post-ICU discharge. Handgrip dynamometry assessed post-ICU motor function (fully corrected T score on the National Institutes of Health Motor Battery Grip Strength Test). Actigraphy estimated post-ICU sleep duration (total sleep time [TST]) and fragmentation (wake after sleep onset) over two consecutive nights from 22:00 p.m. to 06:00 a.m.. We identified differences in grip strength by history of obstructive sleep apnea (OSA) using independent-samples t tests. We examined associations between sleep duration and grip strength using exploratory multivariate regression analyses, after adjustment for clinically relevant covariates. Results Grip strength among this cohort of older ICU survivors was almost 2 SDs below the norm for healthy older adults, indicating considerable ICU-acquired weakness. Grip strength was lower among subjects with history of OSA than those without OSA. Greater TST was associated with worse grip strength, after adjusting for history of OSA and Pittsburgh Sleep Quality Index global score. Moreover, among the subset of male subjects (n = 19), greater TST was significantly and negatively associated with grip strength, after adjusting for Acute Physiology, Age, and Chronic Health Evaluation III score, and Pittsburgh Sleep Quality Index global score. Discussion Sleep promotion may be a potentially modifiable risk factor to mitigate ICU-acquired weakness in older ICU survivors. We propose that improving sleep throughout recovery from critical illness may indirectly promote better outcomes, as poor grip strength is linked to longer length of hospital stay, higher acuity of discharge disposition, and worsened functional decline in older adults.

Cardiopulmonary Endurance of Hospitalized Older Adults With Chronic Obstructive Pulmonary Disease

imageBackground Chronic obstructive pulmonary disease (COPD) could lead to poor cardiopulmonary endurance, which affects quality of life and increases the risk of rehospitalization or mortality. However, studies investigating associated factors of cardiopulmonary endurance for COPD inpatients are scant. Objective The aim of the study was to investigate whether and how age, gender, COPD severity, body composition, dyspnea, respiratory muscle strength, and lower limb muscle strength and endurance were related to cardiopulmonary endurance in elderly inpatients with COPD. Methods This was a cross-sectional study using a systematic sampling of older inpatients. Data of demographic characteristics such as age, gender, and disease severity were collected, and body mass index was calculated. Degrees of dyspnea were assessed by the modified Medical Research Council Dyspnea Scale. Respiratory muscle strength was reflected by the maximal inspiratory pressure and the maximal expiratory pressure. Lower limb muscle strength and endurance were assessed by a handheld dynamometer and a 30-second sit-to-stand test, respectively. Finally, cardiopulmonary endurance was assessed by a 6-minute walk test. Results A total of 83 older COPD inpatients participated. The mean age was 74.01 ± 6.93 years. Cardiopulmonary endurance was associated with age, COPD severity, dyspnea, respiratory muscle strength, lower limb muscle strength, and endurance. Predictors of cardiopulmonary endurance were disease severity, dyspnea, and lower limb muscle endurance. These predictors explained 53% of the variance in cardiopulmonary endurance in older inpatients with COPD. Discussion Cardiopulmonary endurance of hospitalized older adults with COPD should be strengthened by improving conditions of disease severity, dyspnea, and lower limb muscle endurance.

Building a Research Data Repository for Chronic Condition Self-Management Using Harmonized Data

imageBackground Building nursing research data repositories with the goal of comparing and synthesizing results across numerous studies and public sharing of data is still in early stages of development. Objectives We describe the process of using common data elements (CDEs) to build a data repository for research addressing self-management of chronic conditions. Issues in the development of CDEs, lessons learned in the creation of a combined data set across seven studies of different chronic condition populations, and recommendations for creating and sharing harmonized nursing research data sets are provided. Methods In 2014, at initiation of a National Institutes of Health-funded Centers of Excellence in Self-Management Research, our center investigators defined a set of CDEs for use in future center-funded pilot studies consisting of populations having different chronic conditions with the intent to combine the study data sets. Over the next 4 years, center investigators were provided with standardized codebooks and data collection protocols for applying the CDEs and data storage. Data from seven pilot studies were subsequently combined. Results Although each pilot study was small—with sample sizes ranging from 18 to 31 participants—our combined data set of 179 participants provides us with a sample size sufficient to conduct analyses that could not be done with the individual small samples alone. The research data repository addressing self-management of chronic conditions will soon be available for public sharing. Discussion Our experience demonstrates that, with careful, upfront planning and ongoing vigilant oversight, CDEs can be applied across studies consisting of different chronic condition populations to combine data sets to create research data repositories for public sharing.

Back to Science

Por: Pickler · Rita H.
No abstract available

Black Feminist Thought: A Paradigm to Examine Breast Cancer Disparities

imageBackground African American women (AAW) are diagnosed with more aggressive forms of breast cancer when compared to White women and are more likely to die before the age of 45 years. Researchers have suggested that psychological stress could be a precursor to breast cancer. AAW experience a unique form of stress that is a result of living at the intersection of socially constructed roles of race, gender, and class (intersectionality). No studies have used the paradigm of Black Feminist Thought to examine breast cancer disparities among AAW. Objective The purpose of this study was to examine how the intersection of race, gender, and class influences mental and physiological well-being among AAW with breast cancer. Methods A phenomenological design was used. Ten AAW ages 45–60 years were recruited from across the United States. Semistructured interviews were conducted and analyzed using a modified Husserlian approach of descriptive phenomenology. The interviews were audiotaped and transcribed verbatim, and themes were identified using Giorgi’s method. Results Four themes emerged: (a) altruism (selfless giving and caring for others), (b) silent strength (strength in silence while enduring life in the intersection), (c) existential invisibility (an essential, obscured presence in society), and (d) marginalization (living at the margins of society). Marginalization manifested in two forms: (a) passive marginalization (circumstances in which women removed themselves mentally or physically from societal adversity) and (b) active marginalization (circumstances in which women were overlooked, devalued, or ostracized by others). Discussion This study supports the use of Black Feminist Thought to garner knowledge that adds to the discussion of breast cancer disparities. The themes identified suggest other upstream psychosocial risk factors for the development of breast cancer in AAW that stem from life within the societal intersection.

Knowledge of the Human Papillomavirus by Social Stratification Factors

imageBackground Social determinants of health explain most health inequities. Intermediate determinants dictate differences in the exposure and vulnerability of people based on social stratification. Vulnerable women (lower education level, older age, uninsured, etc.) have lower adherence to recommended Pap smear screening guidelines. However, a gap remains concerning the effect of social determinants on human papillomavirus (HPV) infection. Objectives The aim of this study was to analyze the association between the level of knowledge about HPV infection and HPV vaccines with education level and residential setting among a sample of Spanish women. Methods A cross-sectional study at six primary care centers (Cantabria, Spain) was performed. All women >21 years consecutively attended by midwives for routine follow-up were invited to participate during the study period (2015–2016) until a convenience sample was recruited. Participants completed an anonymous questionnaire addressing sociodemographic variables (age, education level, and residential setting) and the level of knowledge regarding HPV infection, including general knowledge about infection and knowledge about the HPV vaccine. Associations between education level (primary, secondary, and university) and residential setting (urban, semiurban, and rural) with the level of knowledge of HPV infection and HPV vaccine were calculated using adjusted logistic regressions. Dose–response associations were estimated based on p-trend. Results Compared to university women, a lower education level was associated with limited or no knowledge of either HPV infection or the HPV vaccine. Women living in rural areas poorly identified “promiscuity” as a risk factor of HPV infection and “the use of condoms” as a protective factor. Moreover, living in rural areas was associated with limited or no knowledge of HPV infection and HPV vaccine. There were significant dose–response trends; those who were more educated and living in more urban areas had more knowledge about either HPV infection or the vaccine. Discussion In our sample, the level of knowledge of HPV infection and HPV vaccine was high. However, vulnerable women, defined by a lower education level and living in rural areas, presented a greater lack of knowledge regarding HPV infection and the HPV vaccine.

Neuroimaging Methods for Nursing Science

imageBackground Since the inception of magnetic resonance imaging, thousands of studies have appeared in the literature reporting on multiple imaging techniques. However, there is a paucity of neuroimaging research programs developed by nurse scientists. Objectives The purpose of this article is to introduce the nurse scientist to complex neuroimaging methods with the ultimate goal of creating impetus for future use of brain imaging in nursing research. Methods This article reviews common neuroimaging methods, presents vocabulary frequently used in neuroimaging work, provides information on access to resources in neuroimaging education, and discusses considerations for use of neuroimaging in research. Results Ten imaging modalities are reviewed, including structural and functional magnetic resonance imaging, computed tomography, positron emission tomography, and encephalography. Discussion Choosing an imaging modality for research depends on the nature of the research question, needs of the patient population of interest, and resources available to the novice and seasoned nurse scientist. Neuroimaging has the potential to innovate the study of symptom science and encourage interdisciplinary collaboration in research.

Oxidative Stress in Pregnant Women Between 12 and 20 Weeks of Gestation and Preterm Birth

imageBackground A known relationship exists between oxidative stress and preterm birth (PTB). However, few studies have measured oxidative stress prospectively in early or midpregnancy, and no studies have used electron paramagnetic resonance (EPR) spectroscopy prospectively to predict PTB. Objective The purpose of this study was to identify predictive relationships between antioxidants and reactive oxygen species (ROS), specifically, superoxide (O2•−), peroxynitrite (OONO−), and hydroxyl radical (●OH), using EPR spectroscopy, measured between 12 and 20 weeks of gestation and compare with the incidence of PTB. Methods Blood was obtained from pregnant women (n = 140) recruited from a tertiary perinatal center. Whole blood was analyzed directly for ROS, O2•−, OONO−, and ●OH using EPR spectroscopy. Red blood cell lysate was used to measure antioxidants. PTB was defined as parturition at

Recruitment of Older Kidney Transplant Recipients to a Longitudinal Study

imageBackground Currently, limited information is available regarding selection of the most successful strategies for recruitment of older adult kidney transplant recipients as research participants. Objective The aim of this study was to explore multiple modes of recruitment strategies to enroll older kidney transplant recipients in a 1-year longitudinal study. Methods We used a feasibility design to explore the following recruitment methods: face-to-face contact in the transplant clinic, paper flyers placed in the transplant clinic, Facebook, an online transplant newsletter, and a university website listing of research studies. Results Enrollment was open for 9 months, during which time websites and the Facebook portal were active, 142 newsletters were e-mailed, and 424 patients were approached in the transplant clinic. Among patients approached in the clinic, 12 did not own a smartphone required for the study. The sample consisted of 60 participants (39 men, 21 women), with a mean age of 64.5 ± 4.7 years. Of the participants who enrolled in the study, the largest number (75%, n = 45) was recruited using the face-to-face method in the transplant clinic. The online transplant newsletter was the second-best recruitment source (18%, n = 11). Discussion Recruitment strategies using face-to-face contact and the online newsletter associated with the transplant clinic organization appeared to be more effective than strategies not associated with the transplant clinic (Facebook and university website). Findings suggest that using a familiar organization communication method to recruit older chronic disease population may be the most beneficial.

Health Literacy and Outcomes of a Community-Based Self-Help Intervention: A Case of Korean Americans With Type 2 Diabetes

imageBackground Although scientific reports increasingly document the negative impact of inadequate health literacy on health-seeking behaviors, health literacy’s effect on health outcomes in patients with diabetes is not entirely clear, owing to insufficient empirical studies, mixed findings, and insufficient longitudinal research. Objective The aim of this study was to empirically examine underlying mechanisms of health literacy’s role in diabetes management among a group of Korean Americans with Type 2 diabetes mellitus. Methods Data from a randomized clinical trial of a health literacy-focused Type 2 diabetes self-management intervention conducted during 2012–2016 in the Korean American community were collected at baseline and at 3, 6, 9, and 12 months. A total of 250 Korean Americans with Type 2 diabetes participated (intervention, 120; control, 130). Participants were first-generation Korean American immigrants. Health literacy knowledge was measured with the original Rapid Estimate of Adult Literacy in Medicine and the diabetes mellitus-specific Rapid Estimate of Adult Literacy in Medicine. Functional health literacy was measured with the numeracy subscale of the Test of Functional Health Literacy in Adults and the Newest Vital Sign screening instrument, which also uses numeracy. Primary outcomes included glucose control and diabetes quality of life. Multivariate analyses included latent variable modeling. Results A series of path analyses identified self-efficacy and self-care skills as significant mediators between health literacy and glucose control and quality of life. Education and acculturation were the most significant correlates of health literacy. Discussion Despite inconsistent findings in the literature, this study indicates that health literacy may indirectly influence health outcomes through mediators such as self-care skills and self-efficacy. The study highlights the importance of health literacy, as well as underlying mechanisms with which health literacy influences processes and outcomes of diabetes self-management.