Background:Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage.Since the management of diabetes is mainly accomplished by patients and families,selfmanagement has be...Background:Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage.Since the management of diabetes is mainly accomplished by patients and families,selfmanagement has become the mainstay of diabetes care.However,a significant proportion of patients fail to engage in adequate self-management.A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes?Purpose/Objectives:The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with TypeⅡdiabetes mellitus.Design:An integrative review design,with a comprehensive methodological approach of reviews,allowing inclusion of experimental and non-experimental studies.Procedures:A comprehensive search was conducted via Ebscohost using databases of Academic Search Complete,CINAHL,Health Source:Nursing/Academic Edition,MEDLINE,PsycArtiCLES,and PsycInfo.The final number of papers used for this review were:motivational interviewing(6),peer support/coaching(10),problem solving therapy(3),technology-based interventions(30),lifestyle modification programs(7),patient education(11),mindfulness(3),and cognitive behavioral therapy(5).Results:Studies were examined from seventeen countries including a broad range of cultures and ethnicities.While interventions have shown mixed results in all interventional categories,many studies do support small to modest improvements in physiologic,behavioral,and psychological outcome measures.Considerable heterogeneity of interventions exists.The most commonly reported physiologic measure was HbA1c level.Outcome measures were collected mostly at 6 and 12 months.Duration of most research was limited to one year.Conclusions:Research exploring the impact of interventions for self-management has made major contributions to the care of persons with type 2 diabetes,from offering suggestions for improving care,to stimulating new questions for research.However,implications for clinical practice remain inconclusive,and limitations in existing research suggest caution in interpreting results of studies.展开更多
Aims:Used as integrated tools,technology may improve access and outcomes of care.A new intervention that integrates multiple technologies called mI SMART has been developed,implemented,and evaluated by Nurse Practitio...Aims:Used as integrated tools,technology may improve access and outcomes of care.A new intervention that integrates multiple technologies called mI SMART has been developed,implemented,and evaluated by Nurse Practitioners.The aim of this paper is to present the initial effectiveness of a webbased,structure of sensors and mobile devices designed to overcome the known health determinant of access to care for rural,chronically ill patients by using technology.Methods:The study was conducted at a community primary-care clinic that provides free healthcare to impoverished adults.Adults with at least one chronic condition,a minimum of 3rd grade reading level,and without dementia/psychosis were recruited.Participants were given a Nexus7 tablet and Bluetooth self-monitoring devices.The intervention lasted for 12 weeks.Blood glucose,blood pressure,and weight were collected using the provided Bluetooth devices and means were evaluated with paired-samples ttests before and after the intervention.Results:Thirty participants were majority female,white,married,high-school educated or less,earning less than$20,000 per annum,and had multiple chronic conditions.Pre-intervention glucose,systolic blood pressure,diastolic blood pressure,weight and Body Mass Index were all reduced after the 12-week intervention.Conclusions:The mI SMART intervention is efficacious for use in improvised adults living in rural areas with multiple chronic conditions.As previously reported,the intervention was also shown to be feasible and acceptable to patients.The next step is a larger randomized controlled trial.展开更多
Objectives:The purpose of this study was to describe relationships between negative emotions and perceived emotional support in parents of children admitted to the pediatric intensive care unit(PICU).Methods:This cros...Objectives:The purpose of this study was to describe relationships between negative emotions and perceived emotional support in parents of children admitted to the pediatric intensive care unit(PICU).Methods:This cross-sectional descriptive study conducted face-to-face interviews between January 2019 and January 2020.Study variables included depression(PHQ-9 Scale),anxiety(Emotional Distress-Anxiety-Short Form 8a),anger(Emotional Distress-Anger-Short Form 5a),fear(Fear-Affect Computerized Adaptive Test),somatic fear(Fear-Somatic Arousal-Fixed Form),loneliness(Revised 20-item UCLA Loneliness Scale),and perceived emotional support(Emotional Support-Fixed Form).Results:Eighty parents reported symptoms of depression 8.00(4.00,13.75),anxiety(23.43±7.80),anger(13.40±5.46),fear(72.81±27.26),somatic fear 9.00(6.00,12.75),loneliness(39.35±12.00),and low perceived emotional support(32.14±8.06).Parents who were young,single,low-income,and with limited-post secondary education reported greater loneliness and lower perceived emotional support.Fear correlated with depression(r=0.737,P<0.01)and anxiety(r=0.900,P<0.01).Inverse relationships were discovered between perceived emotional support and loneliness(r=-0.767,P<0.01),anger(r=-0.401,P<0.01),and depression(r=-0.334,P<0.01).Conclusions:The cluster of negative emotions identified will serve as potential targets for future interventions designed to enhance support for parents of critically ill children.展开更多
Background:Recruiting research participants from primary care in rural Appalachia is a major challenge and can be influenced by cultural characteristics,making it critically important to incorporate strategies of cult...Background:Recruiting research participants from primary care in rural Appalachia is a major challenge and can be influenced by cultural characteristics,making it critically important to incorporate strategies of cultural competence in the overall design of clinical research.Objectives:The purpose of this paper is to describe culturally competent strategies used for recruitment and data collection with a sample of adults with type 2 diabetes from primary care settings in Appalachia.Design:The Purnell model of cultural competence and relevant literature served as a framework for study design.Four overarching approaches informed the organization of recruitment strategies and development of the data collection plan.Procedures:The approaches included selection of research sites,establishing collaborations,sustaining collaborative relationships,and enhancing understanding of benefits of participation.Four recruitment sites were selected based on potential to enhance diversification of participants;multiple steps were included in each of the three remaining approaches to build relationships and gain participation.A study log was maintained to provide evaluation data.Results:Recruitment took 14 months and a sample of 102 subjects provided consent with 101 participants providing complete data.Demographics were representative of the region except that African American participation was higher(6.9%)compared to current north central Appalachia(3%).Over 72%of participants indicated they would be interested in participating in future studies.Conclusions:These findings emphasize the importance of employing strategies for cultural competence in study design.Use of concepts from the Purnell model led to enhanced representativeness and potential for subsequent generalizability.展开更多
Skin cancer rates have risen over the past decades,making it imperative that adults understand the need for protection from sun exposure.Though some risk factors have been identified as predictive for skin cancers,the...Skin cancer rates have risen over the past decades,making it imperative that adults understand the need for protection from sun exposure.Though some risk factors have been identified as predictive for skin cancers,there is a lack of synthesized information about factors that influence adults in their decisions to engage in sun protective behaviors.The purpose of this paper is to present the current state of the science on influential factors for sun protective behaviors in the general adult population.A rigorous literature search inclusive of a generally White,Caucasian,and non-Hispanic adult population was performed,and screening yielded 18 quantitative studies for inclusion in this review.Findings indicate that modifiable and non-modifiable factors are interdependent and play a role in sun protective behaviors.This study resulted in a proposed conceptual model for affecting behavioral change in sun protection including the following factors:personal characteristics,cognitive factors,family dynamics,and social/peer group influences.These factors are introduced to propose tailored nursing interventions that would change current sun protective behavior practice.Key implications for nursing research and practice focus on feasibility of annual skin cancer screening facilitated by advanced practice nurses,incorporating the identified influential factors to reduce skin cancer risk and unnecessary sun exposure.展开更多
Objective: The purpose of this study was to describe the structure of meaning in the experience of surviving stroke for adults living in Appalachia.Methods: This qualitative phenomenological study includes a sample of...Objective: The purpose of this study was to describe the structure of meaning in the experience of surviving stroke for adults living in Appalachia.Methods: This qualitative phenomenological study includes a sample of 6 adult survivors of ischemic stroke who were discharged from either a community or university hospital to home in the Appalachian region. Data was collected through semi-structured interviews, transcribed, and analyzed thematically by two investigators. The explicated themes were verified by the survivors as representative of their experience. Results: Five main themes emerged: 1) Frustration with new physical and functional impairment, 2) Negative emotions including anger, guilt, loneliness, and depression 3) Need for accessible support, 4) Longing for home during recovery and, 5) Stepping forward after stroke which included sub-themes of perseverance, acceptance, and retraining. Anger was described as contributing to delayed recover and emotional lability was described as a source of anger. The familiarity of home was viewed as key to reestablishing control over one's life. Survivors described how they developed perseverance to move forward and emphasized that willingness to participate in retraining led to adapting to impairments. Acceptance was described as letting go of prior expectations of self and others so one could live in the present.展开更多
Objectives:Mothers with substance use disorder(SUD)experience a range of emotions such as feeling ostracized,diminished,and distressed while watching their baby experience withdrawal from substances.Being fully presen...Objectives:Mothers with substance use disorder(SUD)experience a range of emotions such as feeling ostracized,diminished,and distressed while watching their baby experience withdrawal from substances.Being fully present in the now moment is to trust self to do what is best by moving beyond perceived boundaries to care for self and baby.The process of concept building arose from nursing practice encounters in a special care nursery(SCN)for babies who experienced withdrawal from substances.Method:Liehr and Smith’s 10-phase concept building approach was used to guide the development of this concept.Concept building began with a practice story.The emerging concept was named,core qualities identified,and supported through a literature review.The middle range theory of uncertainty in illness was chosen to serve as theoretical support for the concept.A model was created to provide clarity on the relationships within the concept.Result:A mini-saga was gathered from a mother in the SCN whose newborn had experienced withdrawal from substances.The minisaga follows:Due to the baby’s discomfort and judging eyes of the staff,she was unable to mother her baby.As the baby recovered,she asked for help,comforted her baby,and gained confidence to move beyond perceived boundaries to become the mother she envisioned.Overcoming perceived boundaries to attend to self and baby is trusting oneself to do what is best in spite of feeling ostracized,diminished,and distressed while watching baby withdraw from substances.Conclusion:This concept provides the perspective of mothers with SUD through intermodernism from experiences in nursing practice.The Uncertainty in Illness theory further allows practitioners to gain an understanding of the role uncertainty plays in this unique situation.展开更多
Aim:Over 7 million traumatic brain injuries (TBI) are reported each year in the United States.However,treatments and neuroprotection following TBI are limited because secondary injury cascades are poorly understood.Li...Aim:Over 7 million traumatic brain injuries (TBI) are reported each year in the United States.However,treatments and neuroprotection following TBI are limited because secondary injury cascades are poorly understood.Lipopolysaccharide (LPS) administration before controlled cortical impact can contribute to neuroprotection.However,the underlying mechanisms and whether LPS preconditioning confers neuroprotection against closed-head injuries remains unclear.Methods:The authors hypothesized that preconditioning with a low dose of LPS (0.2 mg/kg) would regulate glial reactivity and protect against diffuse axonal injury induced by weight drop.LPS was administered 7 days prior to TBI.LPS administration reduced locomotion,which recovered completely by time of injury.Results:LPS preconditioning significantly reduced the post-injury gliosis response near the corpus callosum,possibly by downregulating the oncostatin M receptor.These novel findings demonstrate a protective role of LPS preconditioning against diffuse axonal injury.LPS preconditioning successfully prevented neurodegeneration near the corpus callosum,as measured by fluorojade B.Conclusion:Further work is required to elucidate whether LPS preconditioning confers long-term protection against behavioral deficits and to elucidate the biochemical mechanisms responsible for LPS-induced neuroprotective effects.展开更多
基金This research did not receive any specific grant from funding agencies in the public,commercial,or not-for-profit sectors
文摘Background:Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage.Since the management of diabetes is mainly accomplished by patients and families,selfmanagement has become the mainstay of diabetes care.However,a significant proportion of patients fail to engage in adequate self-management.A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes?Purpose/Objectives:The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with TypeⅡdiabetes mellitus.Design:An integrative review design,with a comprehensive methodological approach of reviews,allowing inclusion of experimental and non-experimental studies.Procedures:A comprehensive search was conducted via Ebscohost using databases of Academic Search Complete,CINAHL,Health Source:Nursing/Academic Edition,MEDLINE,PsycArtiCLES,and PsycInfo.The final number of papers used for this review were:motivational interviewing(6),peer support/coaching(10),problem solving therapy(3),technology-based interventions(30),lifestyle modification programs(7),patient education(11),mindfulness(3),and cognitive behavioral therapy(5).Results:Studies were examined from seventeen countries including a broad range of cultures and ethnicities.While interventions have shown mixed results in all interventional categories,many studies do support small to modest improvements in physiologic,behavioral,and psychological outcome measures.Considerable heterogeneity of interventions exists.The most commonly reported physiologic measure was HbA1c level.Outcome measures were collected mostly at 6 and 12 months.Duration of most research was limited to one year.Conclusions:Research exploring the impact of interventions for self-management has made major contributions to the care of persons with type 2 diabetes,from offering suggestions for improving care,to stimulating new questions for research.However,implications for clinical practice remain inconclusive,and limitations in existing research suggest caution in interpreting results of studies.
基金The time and research funding for Dr.Mallow to complete this work is supported by the Robert Wood Johnson Foundation Nurse Faculty Scholars Program Grant ID 72119.
文摘Aims:Used as integrated tools,technology may improve access and outcomes of care.A new intervention that integrates multiple technologies called mI SMART has been developed,implemented,and evaluated by Nurse Practitioners.The aim of this paper is to present the initial effectiveness of a webbased,structure of sensors and mobile devices designed to overcome the known health determinant of access to care for rural,chronically ill patients by using technology.Methods:The study was conducted at a community primary-care clinic that provides free healthcare to impoverished adults.Adults with at least one chronic condition,a minimum of 3rd grade reading level,and without dementia/psychosis were recruited.Participants were given a Nexus7 tablet and Bluetooth self-monitoring devices.The intervention lasted for 12 weeks.Blood glucose,blood pressure,and weight were collected using the provided Bluetooth devices and means were evaluated with paired-samples ttests before and after the intervention.Results:Thirty participants were majority female,white,married,high-school educated or less,earning less than$20,000 per annum,and had multiple chronic conditions.Pre-intervention glucose,systolic blood pressure,diastolic blood pressure,weight and Body Mass Index were all reduced after the 12-week intervention.Conclusions:The mI SMART intervention is efficacious for use in improvised adults living in rural areas with multiple chronic conditions.As previously reported,the intervention was also shown to be feasible and acceptable to patients.The next step is a larger randomized controlled trial.
基金This work was supported by the West Virginia University School of Nursing Research Investment Fund.
文摘Objectives:The purpose of this study was to describe relationships between negative emotions and perceived emotional support in parents of children admitted to the pediatric intensive care unit(PICU).Methods:This cross-sectional descriptive study conducted face-to-face interviews between January 2019 and January 2020.Study variables included depression(PHQ-9 Scale),anxiety(Emotional Distress-Anxiety-Short Form 8a),anger(Emotional Distress-Anger-Short Form 5a),fear(Fear-Affect Computerized Adaptive Test),somatic fear(Fear-Somatic Arousal-Fixed Form),loneliness(Revised 20-item UCLA Loneliness Scale),and perceived emotional support(Emotional Support-Fixed Form).Results:Eighty parents reported symptoms of depression 8.00(4.00,13.75),anxiety(23.43±7.80),anger(13.40±5.46),fear(72.81±27.26),somatic fear 9.00(6.00,12.75),loneliness(39.35±12.00),and low perceived emotional support(32.14±8.06).Parents who were young,single,low-income,and with limited-post secondary education reported greater loneliness and lower perceived emotional support.Fear correlated with depression(r=0.737,P<0.01)and anxiety(r=0.900,P<0.01).Inverse relationships were discovered between perceived emotional support and loneliness(r=-0.767,P<0.01),anger(r=-0.401,P<0.01),and depression(r=-0.334,P<0.01).Conclusions:The cluster of negative emotions identified will serve as potential targets for future interventions designed to enhance support for parents of critically ill children.
文摘Background:Recruiting research participants from primary care in rural Appalachia is a major challenge and can be influenced by cultural characteristics,making it critically important to incorporate strategies of cultural competence in the overall design of clinical research.Objectives:The purpose of this paper is to describe culturally competent strategies used for recruitment and data collection with a sample of adults with type 2 diabetes from primary care settings in Appalachia.Design:The Purnell model of cultural competence and relevant literature served as a framework for study design.Four overarching approaches informed the organization of recruitment strategies and development of the data collection plan.Procedures:The approaches included selection of research sites,establishing collaborations,sustaining collaborative relationships,and enhancing understanding of benefits of participation.Four recruitment sites were selected based on potential to enhance diversification of participants;multiple steps were included in each of the three remaining approaches to build relationships and gain participation.A study log was maintained to provide evaluation data.Results:Recruitment took 14 months and a sample of 102 subjects provided consent with 101 participants providing complete data.Demographics were representative of the region except that African American participation was higher(6.9%)compared to current north central Appalachia(3%).Over 72%of participants indicated they would be interested in participating in future studies.Conclusions:These findings emphasize the importance of employing strategies for cultural competence in study design.Use of concepts from the Purnell model led to enhanced representativeness and potential for subsequent generalizability.
文摘Skin cancer rates have risen over the past decades,making it imperative that adults understand the need for protection from sun exposure.Though some risk factors have been identified as predictive for skin cancers,there is a lack of synthesized information about factors that influence adults in their decisions to engage in sun protective behaviors.The purpose of this paper is to present the current state of the science on influential factors for sun protective behaviors in the general adult population.A rigorous literature search inclusive of a generally White,Caucasian,and non-Hispanic adult population was performed,and screening yielded 18 quantitative studies for inclusion in this review.Findings indicate that modifiable and non-modifiable factors are interdependent and play a role in sun protective behaviors.This study resulted in a proposed conceptual model for affecting behavioral change in sun protection including the following factors:personal characteristics,cognitive factors,family dynamics,and social/peer group influences.These factors are introduced to propose tailored nursing interventions that would change current sun protective behavior practice.Key implications for nursing research and practice focus on feasibility of annual skin cancer screening facilitated by advanced practice nurses,incorporating the identified influential factors to reduce skin cancer risk and unnecessary sun exposure.
基金This study was supported by the West Virginia University School of Nursing Research FundWest Virginia University Healthcare(Horstman)the Robert Wood Johnson Nurse Faculty Scholars Program(Theeke Award Number 58035 and Mallow Award Num-ber 72119).and the WVU Clinical Translational Research Scholar(NIH/NIGMS Award Number U54GM104942)(Mallow).
文摘Objective: The purpose of this study was to describe the structure of meaning in the experience of surviving stroke for adults living in Appalachia.Methods: This qualitative phenomenological study includes a sample of 6 adult survivors of ischemic stroke who were discharged from either a community or university hospital to home in the Appalachian region. Data was collected through semi-structured interviews, transcribed, and analyzed thematically by two investigators. The explicated themes were verified by the survivors as representative of their experience. Results: Five main themes emerged: 1) Frustration with new physical and functional impairment, 2) Negative emotions including anger, guilt, loneliness, and depression 3) Need for accessible support, 4) Longing for home during recovery and, 5) Stepping forward after stroke which included sub-themes of perseverance, acceptance, and retraining. Anger was described as contributing to delayed recover and emotional lability was described as a source of anger. The familiarity of home was viewed as key to reestablishing control over one's life. Survivors described how they developed perseverance to move forward and emphasized that willingness to participate in retraining led to adapting to impairments. Acceptance was described as letting go of prior expectations of self and others so one could live in the present.
文摘Objectives:Mothers with substance use disorder(SUD)experience a range of emotions such as feeling ostracized,diminished,and distressed while watching their baby experience withdrawal from substances.Being fully present in the now moment is to trust self to do what is best by moving beyond perceived boundaries to care for self and baby.The process of concept building arose from nursing practice encounters in a special care nursery(SCN)for babies who experienced withdrawal from substances.Method:Liehr and Smith’s 10-phase concept building approach was used to guide the development of this concept.Concept building began with a practice story.The emerging concept was named,core qualities identified,and supported through a literature review.The middle range theory of uncertainty in illness was chosen to serve as theoretical support for the concept.A model was created to provide clarity on the relationships within the concept.Result:A mini-saga was gathered from a mother in the SCN whose newborn had experienced withdrawal from substances.The minisaga follows:Due to the baby’s discomfort and judging eyes of the staff,she was unable to mother her baby.As the baby recovered,she asked for help,comforted her baby,and gained confidence to move beyond perceived boundaries to become the mother she envisioned.Overcoming perceived boundaries to attend to self and baby is trusting oneself to do what is best in spite of feeling ostracized,diminished,and distressed while watching baby withdraw from substances.Conclusion:This concept provides the perspective of mothers with SUD through intermodernism from experiences in nursing practice.The Uncertainty in Illness theory further allows practitioners to gain an understanding of the role uncertainty plays in this unique situation.
文摘Aim:Over 7 million traumatic brain injuries (TBI) are reported each year in the United States.However,treatments and neuroprotection following TBI are limited because secondary injury cascades are poorly understood.Lipopolysaccharide (LPS) administration before controlled cortical impact can contribute to neuroprotection.However,the underlying mechanisms and whether LPS preconditioning confers neuroprotection against closed-head injuries remains unclear.Methods:The authors hypothesized that preconditioning with a low dose of LPS (0.2 mg/kg) would regulate glial reactivity and protect against diffuse axonal injury induced by weight drop.LPS was administered 7 days prior to TBI.LPS administration reduced locomotion,which recovered completely by time of injury.Results:LPS preconditioning significantly reduced the post-injury gliosis response near the corpus callosum,possibly by downregulating the oncostatin M receptor.These novel findings demonstrate a protective role of LPS preconditioning against diffuse axonal injury.LPS preconditioning successfully prevented neurodegeneration near the corpus callosum,as measured by fluorojade B.Conclusion:Further work is required to elucidate whether LPS preconditioning confers long-term protection against behavioral deficits and to elucidate the biochemical mechanisms responsible for LPS-induced neuroprotective effects.
