Physical Heart Failure Symptom Clusters Predictive of Delay in Seeking Treatment.

BACKGROUND: Recent research has focused on the relationship between heart failure (HF) symptom clusters and outcomes, including mortality, hospitalization, functional status, and quality of life. No known studies to date have explored the role of physical HF symptom clusters and delays in seeking treatment. OBJECTIVES: Describe physical symptom clusters in a population of HF patients and determine if a specific cluster is predictive of delay in seeking treatment for HF symptoms. METHOD: We analyzed combined data from two studies (n = 406) collected during acute HF hospitalization. The Heart Failure Somatic Awareness Scale quantified physical HF symptoms. Delay, measured in days, was collected from the medical record and confirmed by interview. Hierarchical agglomerative clustering techniques determined physical HF symptom clusters. Hierarchical multiple regression analysis was computed to explore predictors of delay. RESULTS: Participants were primarily White, male sex older adults. Three physical HF symptom clusters were identified: discordant, edema-related symptoms, and dyspnea-related symptoms. Hierarchical multiple regression analysis revealed in Step 1 that age was a significant predictor of delay. DISCUSSION: Our findings provide valuable insight into the role of physical symptom clusters on delay in persons with HF. Through agglomerative hierarchical clustering techniques, we found three physical HF symptom clusters that were then used to determine differences in cluster membership by demographic and clinical variables. Significant age differences were noted by cluster membership with youngest older adults in a discordant symptom cluster.

Perspectives Regarding Engagement in Physical Activity in Women: Traditional Gender Role-Based Themes.

BACKGROUND: There has not been a significant improvement in cardiovascular disease (CVD) statistics among women; 44.4% of women older than 20 years have a diagnoses of CVD. Only 24.3% of adults meet physical activity (PA) guidelines, women have significantly lower levels of PA significantly lower levels than men. There is a call to action from the American Heart Association to delineate reasons for related genderized, socially determined factors. OBJECTIVE: The purpose of this study was to use the individual and family self-management theory to explore and describe interacting sociodemographic, family, cultural, health/access-related, and personal factors contributing to PA engagement in women living in areas of reduced socioeconomic resources. METHODS: This study used a community-engaged, qualitative descriptive focus group design to explore PA engagement in women between 18 and 64 years old living in an area of reduced socioeconomic resources and high racial and ethnic diversity. RESULTS: Context-related factors included cost/access, transportation, safety, and setting and interacted with family structure and functioning. Process-level factors affecting PA engagement included outcome expectancy, goal incongruence, lack of self-efficacy, self-regulation, and provider support/collaboration. Facilitators included family/friend social support. CONCLUSIONS: The current community-engaged study reveals socially constructed gender role elements related to family dynamics, self-perception, and self-regulation that potentially impact engagement in self-management behavior. Programs to increase awareness and self-management of CVD in women exist, but there is a lack of direct effects, speaking to unknown factors. Given perpetually high rates of CVD, low levels of PA, and declining knowledge levels among women, further investigation is imperative.

Knowledge, attitudes, and practices of primary healthcare providers with assessing and supporting older informal caregivers.

A time burden, financial strain, and prioritizing care recipient needs over their own are key barriers preventing informal caregivers from engaging in health-promoting self-care. Primary healthcare providers are well positioned to assess and support informal caregivers. A cross sectional descriptive, correlational study was used to examine the knowledge, attitudes, and practices of healthcare providers regarding assessment and support of older informal caregivers. The Healthcare Professional Facilitated Health Promotion (HPFHP) Model guides this study by depicting the collaborative patient-healthcare professional relationship. The Caregiver Self-Care Survey for Healthcare Providers measured the knowledge, attitudes, and practices of 80 healthcare providers on assessing and supporting older informal caregivers. Descriptive and inferential statistics were calculated using IBM Statistical Package for the Social Sciences (SPSS) 28.0 software. Results indicated that despite positive attitudes, knowledge deficit and system level barriers prevented integration of caregiver assessment in practice. A caregiver identification process, user-friendly assessment tool, and system level changes are overdue.

Nursing Student Perceptions of Academic and Clinical Integrity.

AIM: This study aimed to explore how nursing students define and describe academic and clinical integrity and to identify social and psychological influences on student decisions to act with integrity. BACKGROUD: Nursing students are exhibiting a decline in academic and clinical integrity. Academic dishonesty often correlates to clinical dishonesty, subsequently impacting patient care quality and safety. Student perceptions and understanding of integrity are unknown. METHOD: A qualitative descriptive approach guided this study. A purposive sample of 19 traditional baccalaureate nursing students was recruited to participate in one-hour face-to-face interviews. RESULTS: All participants defined academic and clinical integrity as honest, ethical, and accountable behavior. Additional subthemes of characteristics, facilitators and barriers, and outcomes of acting with integrity emerged. CONCLUSION: Students recognize the positive characteristics of integrity and their effects on personal growth and optimal patient outcomes. These findings can inform faculty in developing and supporting a culture of integrity.

Personal, social and cultural factors affecting elders' transitions to long term care: Certified nursing assistant perspectives.

A focus group methodology was employed to elicit information from Certified Nursing Assistants (CNAs) about their views of the personality, social, institutional and cultural factors that affect the success or failure of elders' adaptation to nursing home life. The focus group (N = 6) was conducted in one long-term care facility. CNAs identified three themes that represent the process of successful adaptation to the nursing home. Emotional displacement was followed by a period of assimilation and acceptance. Resident personality, social, institutional and cultural characteristics that may affect each stage of the process are described. This study supports previous findings regarding the contribution of social-environmental elements in the adjustment process. CNA perceptions of factors that assist elders during the transition process proved to be a valuable source of information.

The impact of demographic and self-management factors on physical activity in women.

AIM: Guided by the Individual and Family Self-Management Theory, this study examines demographic and self-management variables that impact the outcome of physical activity. BACKGROUND: Multiple sources indicate relationships between physical activity and reduced incidence of cardiovascular disease. Women engage in significantly less physical activity than guidelines recommend. METHODS: Data collected in women included demographic/situational factors and external influencing level factors including knowledge and beliefs, social facilitation, and outcome expectancy. The outcome behavior physical activity was also assessed. Correlation and hierarchical multiple regression were used to examine the relationship of demographic/situational and external influencing factors to physical activity. RESULTS: The sample included 119 women (mean age 40.96, 89.1% Caucasian, 51.3% Married, 95% high school graduates). Education was positively correlated with exercise benefits (r = 0.235,p = .010). Gross family income (r = 0.191,p = .043), work status (r = 0.238,p = .009), and health insurance(r = 0.228,p = .013) were positively correlated to family participation, and work status was positively correlated to friend participation (r = 0.263.p = .004). In the final model, demographic/situational factors (step 1) explained 12.9% of the variance in physical activity (p < .05). Knowledge and beliefs, social support, and outcome expectancy (step added an additional 0.9% of variance physical activity levels). CONCLUSIONS: Findings suggest that demographic/situational factors contribute more to explaining variability in physical activity levels than external influencing factors. This suggests that in addition to considering demographic variables, further research to explore other demographic/situational and external influencing factors that affect physical activity specifically in women is necessary.

Uncertainty levels differ by physical heart failure symptom cluster.

BACKGROUND: The role of uncertainty, unpredictable symptoms, and unknown illness trajectory are frequent concerns reported in heart failure (HF) literature. Illness uncertainty can lead to difficulty interpreting symptoms, potentially impacting outcomes. Impaired functional status, quality of life, all-cause mortality, rehospitalization, and event-free survival are predicted by symptom clusters. No studies to date describe levels of uncertainty by physical symptom cluster in HF. AIMS: Describe physical HF symptom clusters and determine if uncertainty levels differ by symptom cluster. METHODS: Results are based on a secondary analysis of data from patients hospitalized with an acute exacerbation of HF. The Heart Failure Somatic Perception Scale (HFSPS) and Mishel's Uncertainty in Illness Scale (MUIS-C) were completed. Symptom clusters were determined by hierarchical agglomerative clustering. Controlling for age and gender, ANCOVA (post hoc LSD) analyses explored uncertainty levels by symptom cluster group. RESULTS: One hundred and thirty-three primarily older (76.4 ± 12.1), Caucasian (92.5%) adults (55.2% male), with an ischemic HF etiology (71.6%) were enrolled. Three clusters were found: 1. Shortness of breath, n = 47, 2. Edema, n = 39, and 3. Cardiac, n = 43. Adjusting for age and gender, uncertainty levels differed by cluster group (p ≤ 0.001), with edema cluster members reporting greater illness uncertainty than cardiac cluster members (74.6 vs 69.5, respectively, p = 0.033). CONCLUSIONS: Differences exist in illness uncertainty levels based on the symptom experience of patients with HF. Care and management of HF symptoms should include a complete assessment of unique symptom cluster profiles.

Entry and Passage Variables Associated with Nursing Home Adjustment in Older Adults with Dementia.

A theory-guided non-experimental, descriptive, correlational design was used to evaluate how entry and passage variables were related to nursing home adjustment for individuals with dementia. Older adults with dementia may be unable to speak for themselves, therefore proxy responses of Certified Nursing Assistants (CNAs) provided the data for completion of the Nursing Home Adjustment Scale.1 Guided by the Meleis' Theory of Transitions, entry level factors (i.e. age, previous residence, gender, and choice), and passage variables (i.e. length of stay, extent of dementia, functional abilities, and depression) were entered into a regression equation as predictors of nursing home adjustment. Information about extent of dementia, functional abilities and depression was derived from the Minimum Data Set (MDS) maintained for all residents per Medicare and Medicaid guidelines. Descriptive and inferential statistics were calculated using IBM Statistical Package for the Social Sciences (SPSS) 26.0 software. Results indicated an inverse relationship between nursing home adjustment and depression as measured by the PHQ-9. There was no support for relationships among other variables. CNA proxy responses were found to be reliable in that they were significantly correlated with nursing responses on the same measure. This study supports the use of CNA proxy responses as a method to evaluate the experience of individuals with dementia.

Predictors of psychological distress and sleep quality in former family caregivers of people with dementia.

Objectives: The stress-related psychological symptoms experienced by informal family caregivers do not always improve or resolve after the death of the care recipient. The purpose of this study was to explore the independent associations of sociodemographic variables, personality and coping, environmental variables, and caregiver guilt with the sleep quality and psychological distress of former family caregivers of individuals with dementia following care recipient's death.Method: A cross-sectional, correlational study was conducted with a sample of 171 former family caregivers of people with dementia. Participants completed an online survey comprised of six instruments and demographic items. Caregiver personal variables (e.g. personality and coping), environmental variables, guilt, psychological distress (depressive and anxiety symptoms), and sleep quality were evaluated using psychometrically validated measures.Results: In bivariate analysis, post-caregiving guilt was significantly associated with depressive and anxiety symptoms (p < 0.01). After controlling for covariates, dysfunctional coping and neuroticism explained 32% of the variance in depressive symptoms (R2 = .52, ΔR2 = .32, F(5, 165) = 36.24, p < .001) and 24% of the variance in anxiety symptoms (R2 = .41, ΔR2 = .24, F(5, 165) = 22.65, p < .001), while dysfunctional coping, pre-loss depression, and extraversion accounted for 16% of the variance in sleep quality (R2 = .30, ΔR2 = .16, F(6, 164) = 11.44, p < .001).Conclusion: This study demonstrates the critical role of personal variables, including personality traits, coping strategies, and pre-loss depression, in explaining psychological distress and sleep quality in this sample of former dementia caregivers.

Patterns of Heart Failure Dyadic Illness Management: The Important Role of Gender.

BACKGROUND: The ways in which patients with heart failure (HF) and their care partners work together to manage HF are often overlooked. OBJECTIVE: The aim of this study was to identify and compare different patterns of HF dyadic illness management. METHODS: This was a secondary analysis of data on HF dyads. Heart failure management was measured using patient and care partner versions of the Self-Care of HF Index and European HF Self-care Behavior Scale. Latent class modeling was used to identify patterns of HF dyadic management. RESULTS: The mean age of the 62 patients and their care partners was 59.7 ± 11.8 and 58.1 ± 11.9 years, respectively. A majority of patients (71.0%) had class III/IV HF, and a majority of the couples (95.2%) were married. Two distinct dyadic patterns were observed, 1 collaborative management type (n = 42, 67.7%) and 1 autonomous management type (n = 20, 32.3%). Dyads in the autonomous pattern were mostly female patients with male care partners; patients in this pattern also were more anxious and depressed, and reported worse relationship quality compared with collaborative dyads. CONCLUSION: There is an engendered spectrum of collaboration in how HF patient-care partner dyads work together to manage HF that needs to be considered in clinical care and research.

Substance Use and Minority Stress in a Population of Lesbian, Gay and Bisexual Nurses.

PURPOSE: The aim of this study was to explore the incidence of problematic substance use (PSU) and the relationship between level of substance use, minority stress, and general stressors in a population of lesbian, gay and bisexual (LGB) identified nurses. Methods: A national, convenience sample of 394 self-identified LGB nurses completed an online survey in March 2019. Using data from the ASSIST V3.1 measurement tool, the incidence of problematic and non-problematic tobacco, alcohol and illicit substance use was described as a percentage of respondents in each group. Hierarchical regression assessed the impact of demographic variables, sexual orientation, gender identity, race/ethnicity, and level of substance use. Multiple regression assessed the impact of general stressors, minority stress processes, including coping and social support and internalized homophobia, on level of substance use. Results: The incidence of PSU was higher in this population of LGB-identified nurses than previously described in either the general population of nurses or the general LGB population. Demographic variables and minority status had variable associations with level of tobacco, alcohol and illicit substance use. Components of Meyer's minority stress model had a stronger and more consistent association with level of tobacco, alcohol and illicit substance use than general stress. Predictors of level of substance use across groups suggest community involvement may be significant. These results have potential implications for public health and the prevention and treatment of substance use in LGB-identified nurses.

Use of Music Lyrics to Engage Millennial Learners in Undergraduate Research.

Undergraduate research, a high-impact learning practice, peaks interest and enthusiasm for research and contributes to development of research process knowledge, skills, and competency. Fifty millennial sophomore nursing students participated in the innovative learning activity using lyrics from popular songs to complete qualitative analysis in a research course. Students analyzed, synthesized, and developed themes from music lyrics that helped them to more fully understand the processes and perspectives of qualitative research. This activity taught students about qualitative research and provided an opportunity to develop analysis, synthesis, and teamwork knowledge and skills transferable to the professional environment.

Executive dysfunction is associated with self-care confidence in patients with heart failure.

AIM: To explore differences in self-care maintenance, management and confidence levels between American heart failure (HF) patients with and without executive dysfunction. BACKGROUND: Evidence indicates some aspect of cognitive impairment is prevalent in up to 75% of the HF patient population. Moreover, cognitive impairment has been identified as a barrier to adequate self-care contributing to poor outcomes. There is limited understanding of the role executive function, a domain of cognitive performance, has on self-care behaviors for patients with HF. METHOD: This secondary analysis examined the role of executive function, measured by the Clock Drawing Test (CDT), in relation to self-care measures. The Self Care of Heart Failure Index v6.2 (SCHFI v6.2) was used to measure self-care maintenance, management, and confidence. RESULTS: Participants had a mean age of 75.1 ± 12.5 years, identified as male (59.4%), with New York Heart Association (NYHA) class III (57.3%). Executive function impairment was present in 28% of the sample. Comparison of self-care maintenance and management scores between the two groups were not significant. However, participants with executive dysfunction demonstrated an average self-care confidence score of 48.6 ± 23.3, while participants with no executive function impairment demonstrated a higher average self-care confidence score of 61.5 ± 18.4. Differences in self-care confidence scores between the groups were statistically significant (p = .014). CONCLUSIONS: HF self-care confidence is considered a moderator of self-care behaviors. Understanding the influence executive function has on self-care confidence may lead to a better understanding of those needing greater support with self-care behaviors.

Psychometric Testing of the Revised Self-Care of Heart Failure Index.

BACKGROUND: Self-care is essential in people with chronic heart failure (HF). The process of self-care was refined in the revised situation specific theory of HF self-care, so we updated the instrument measuring self-care to match the updated theory. The aim of this study was to test the psychometric properties of the revised 29-item Self-Care of Heart Failure Index (SCHFI). METHODS: A cross-sectional design was used in the primary psychometric analysis using data collected at 5 sites in the United States. A longitudinal design was used at the site collecting test-retest data. We tested SCHFI validity with confirmatory factor analysis and predictive validity in relation to health-related quality of life. We tested SCHFI reliability with Cronbach α, global reliability index, and test-retest reliability. RESULTS: Participants included 631 adults with HF (mean age, 65 ± 14.3 years; 63% male). A series of confirmatory factor analyses supported the factorial structure of the SCHFI with 3 scales: Self-Care Maintenance (with consulting behavior and dietary behavior dimensions), Symptom Perception (with monitoring behavior and symptom recognition dimensions), and Self-Care Management (with recommended behavior and problem-solving behavior dimensions). Reliability estimates were 0.70 or greater for all scales. Predictive validity was supportive with significant correlations between SCHFI scores and health-related quality-of-life scores. CONCLUSIONS: Our analysis supports validity and reliability of the SCHFI v7.2. It is freely available to users on the website: www.self-care-measures.com.

Concurrent validity and acceptability of health literacy measures of adults hospitalized with heart failure.

OBJECTIVES: To test concurrent validity and acceptability of the Single Item Literacy Screener (SILS), Test of Functional Health Literacy (S-TOFHLA) and the Newest Vital Sign (NVS) in hospitalized adults with heart failure (HF). BACKGROUND: Health literacy is not routinely evaluated in adults hospitalized with HF. Low health literacy is linked to poor HF self-care and hospital readmissions. METHODS: SILS, NVS and S-TOFHLA were completed by 85 patients with HF. Measures were examined for internal consistency reliability and acceptability. The NVS and S-TOFHLA were correlated with the SILS to establish concurrent validity. RESULTS: The NVS (α = 0.70) and S-TOFHLA (α = 0.88) were reliable. The SILS significantly correlated with the S-TOFHLA (r = -0.308). The S-TOFHLA (M = 6.16) and NVS (M = 6.10) were acceptable measures. CONCLUSION: The S-TOFHLA and NVS were reliable and acceptable measures of health literacy in hospitalized HF population. The SILS correlated with the S-TOFHLA and may predict low health literacy when hospitalized. NVS total scores in this population aligned with the recent NAAL survey. Hospitalized adults with HF agreed to share the health literacy scores with their providers.

Nurses' attitudes and emotions toward caring for adults with intellectual disabilities: Results of a cross-sectional, correlational-predictive research study.

BACKGROUND: Negative healthcare provider attitudes may contribute to healthcare disparities in adults with intellectual disabilities. This study identified predictors of nurses' attitudes and emotions toward caring for adults with intellectual disabilities in the United States. METHOD: A convenience sample of 248 nurses was used to collect nurses' attitudes and emotions toward caring for adults with intellectual disabilities (Adapted Caring for Adults with Disabilities Questionnaire) and quality of life beliefs (Prognostic Beliefs Scale). RESULTS: Overall, nurses held less positive attitudes toward caring for an adult with intellectual disability versus a physical disability. Intellectual disability nurses held more positive attitudes and emotions and less negative emotions than non-intellectual disability nurses. Quality of life beliefs predicted nurse attitude, positive emotions and negative emotions. The number of adults with intellectual disabilities cared for during the nurse's career predicted negative emotions. CONCLUSIONS: Future interventions should focus on improving nurses' understanding of the quality of life of adults with intellectual disabilities.

Development and initial testing of the self-care of chronic illness inventory.

AIM: The aim was to develop and psychometrically test the self-care of chronic illness Inventory, a generic measure of self-care. BACKGROUND: Existing measures of self-care are disease-specific or behaviour-specific; no generic measure of self-care exists. DESIGN: Cross-sectional survey. METHODS: We developed a 20-item self-report instrument based on the Middle Range Theory of Self-Care of Chronic Illness, with three separate scales measuring Self-Care Maintenance, Self-Care Monitoring, and Self-Care Management. Each of the three scales is scored separately and standardized 0-100 with higher scores indicating better self-care. After demonstrating content validity, psychometric testing was conducted in a convenience sample of 407 adults (enrolled from inpatient and outpatient settings at five sites in the United States and ResearchMatch.org). Dimensionality testing with confirmatory factor analysis preceded reliability testing. RESULTS: The Self-Care Maintenance scale (eight items, two dimensions: illness-related and health-promoting behaviour) fit well when tested with a two-factor confirmatory model. The Self-Care Monitoring scale (five items, single factor) fitted well. The Self-Care Management scale (seven items, two factors: autonomous and consulting behaviour), when tested with a two-factor confirmatory model, fitted adequately. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model. CONCLUSION: The self-care of chronic illness inventory is adequate in reliability and validity. We suggest further testing in diverse populations of patients with chronic illnesses.

Utilizing Internet-based recruitment and data collection to access different age groups of former family caregivers.

As Internet accessibility grows among adults in the United States, researchers' utilization of Internet-based surveys and recruitment strategies has increased, but there is a paucity of knowledge about their use in different age groups of former dementia caregivers. The purpose of this secondary analysis is to describe 1) the use of Internet-based recruitment in obtaining a sample inclusive of young and middle aged (age 18-64), young-old (age 65-74), and older-old (age 75 and older) former dementia caregivers and 2) the feasibility of collecting data using an online survey in young and middle aged, young-old, and older-old former dementia caregivers. Utilizing convenience sampling, a four-step recruitment strategy encompassing a combination of Internet-based and non-Internet-based recruitment strategies was employed. Participants (N = 171) completed an online survey. Older-old, young-old, and young and middle-aged participants comprised 9%, 30%, and 61% of the sample respectively. All age cohorts provided minimal missing data using an online survey, but older-old participants required 15 additional minutes to complete the survey than young-old participants. Both cohorts of older adults were directed to the survey less frequently through online referral sources than young and middle-aged participants, and no older-old participants were referred via Facebook. All three age cohorts consisted of mostly white women. Internet-based surveys and recruitment were feasible among the age groups but may present challenges for the older-old and minorities. Further research on Internet-based data collection and recruitment is indicated in minority and older-old caregivers, focusing on trust, educational and financial disparities, and technological proficiency as potential barriers.

Chronic Sorrow in Parents of Children with a Chronic Illness or Disability: An Integrative Literature Review.

PROBLEM: This integrative review aims to synthesize the findings of studies on chronic sorrow in parents, to analyze the findings along three specific research questions, and to identify areas for future research. ELIGIBILITY CRITERIA: Studies of parents, mothers and/or fathers of non-adult children published in peer-reviewed journals that answered the research questions: 1) How does the experience of chronic sorrow differ between mothers and fathers? 2) What factors have been identified to impact the experience of chronic sorrow over time? 3) What strategies by health care providers for helping parents cope with chronic sorrow have been identified to be most and least helpful? SAMPLE: Nineteen studies from a literature search within the databases of CINAHL, MEDLINE, PsycINFO, Psycarticles and SocIndex were included in the review. RESULTS: Findings suggest that mothers experience more intense chronic sorrow compared with fathers. Health care crises and developmental milestones are potent triggers for resurgence of chronic sorrow. Helpful strategies by healthcare providers include providing information, helping to procure respite and being empathetic and compassionate. CONCLUSIONS: Healthcare providers need to understand that chronic sorrow is a normal consequence of having a child with a chronic illness or disability. IMPLICATIONS: Family-centered interventions should be individualized and aimed at providing increased comfort to parents in times of need. Further research that looks at the effectiveness of interventions is needed.

Predictors of delay in heart failure patients and consequences for outcomes.

Persons with heart failure (HF) symptoms delay up to 7 days before seeking treatment. Delay can result in worse symptoms and potentially impact outcomes. The purpose of this review was to describe predictors and outcomes of delay in HF patients. Demographic factors, increased symptom number, social factors, greater HF knowledge, lower anxiety, and depression predicted increased delay. HF patients had difficulty recognizing and interpreting symptoms of HF. Results are conflicting related to symptom pattern, time of care seeking, and history of HF as predictors of delay. The only outcome predicted by delay was length of stay with those delaying longer reporting longer lengths of stay. Future research related to delay should include theoretical frameworks and larger, more ethnically diverse samples from multiple sites and link delay to outcomes. Valid and reliable instruments are needed to measure delay and related factors. HF education should include supportive others.