Perceived Stress and Life Stressors in Adults with and without Fibromyalgia.

Chronic medical conditions (i.e., chronic widespread pain) may contribute to accelerated/accentuated aging, such that middle-aged individuals with comorbidities may actually show increased declines in physical, cognitive, and mental health compared to normal aging adults. We examined perceived stress, life stressors, and depression in adults with and without fibromyalgia, a chronic pain condition. Ninety-four participants (52% with fibromyalgia, 78% female) aged 50 to 93 were administered the Perceived Stress Scale, Social Readjustment Rating Scale, and Beck Depression Inventory. Hierarchical regression analyses were conducted: the predictor variables were age, gender, fibromyalgia status, depression, and fibromyalgia-depression interaction. The interaction term significantly predicted perceived stress, but not life stressors. Depression significantly predicted stress for Social Readjustment Rating Scale measures after controlling for covariates. Significant associations were found between perceived stress and life stressors in all participants. In addition, those with fibromyalgia were significantly more likely to report higher levels of stress above standardized scores on both the Perceived Stress Scale and the Social Readjustment Rating Scale. Finally, depressive symptoms played a more significant role than fibromyalgia status in predicting life stressors. Conclusions: These findings emphasize the importance of assessing different types of stress and stressors in individuals with chronic widespread pain and/or depression in mid-life and beyond to better treat individuals with these conditions.

The Quality Improvement Review Board: An Innovative Approach to Oversight of Projects That Do Not Meet Criteria of Human Subject Research.

This article describes the development of an institutional quality improvement review board (QIRB) as an effective and efficient method for reviewing and overseeing institutional quality improvement (QI) initiatives. QI projects involve the systematic collection and analysis of data and the implementation of interventions designed to improve the quality of clinical care and/or educational programs for a distinct population in a specific setting. QI projects are fundamentally distinct from human subjects research (HuSR); however, the differences between them are subtle and highly nuanced. Determining whether a project meets the definition of QI or qualifies as HuSR, thus requiring institutional review board (IRB) review, can be confusing and frustrating. Nevertheless, this distinction is highly consequential due to the heavy regulatory requirements involved in HuSR and IRB oversight. Making the correct determination of a project's regulatory status is essential before the project begins. Project leaders may not realize that their work meets the definition of HuSR and, therefore, might conduct the project without appropriate IRB review. Therefore, best practices dictate that project leaders should not decide which type of institutional review is appropriate for their projects. In addition, when QI project teams attempt to disseminate the results of their work, documentation of formal review and approval is generally required by peer-reviewed journals and professional organizations. However, institutional review mechanisms are rarely available. Projects that do not meet the definition of HuSR fall outside the purview of IRBs and most institutions do not have an alternative review body. This creates frustration for both project leaders and IRB administrators. Apart from IRB review, a separate process for reviewing QI projects offers several benefits. These include (1) relieving the burden on busy IRB staff; (2) promoting scholarly activity; (3) protecting the institution, project leaders, and participants from HuSR conducted outside of appropriate IRB review; and (4) promoting rigorous QI methods.

Fibromyalgia status and depressive symptoms are linked to body mass index and physical performance in mid to late life.

Fibromyalgia (FM) is a chronic pain condition that is frequently accompanied by comorbid conditions, including depression. Depression is associated with reduced physical functioning and health, disproportionately affecting middle-aged and older adults with FM. This study examined associations between FM status and depressive symptoms with body mass index (BMI) and several physical performance indicators among middle-aged and older adults. Participants included 239 community-dwelling middle-aged and older adults with or without FM. Depressive symptoms were measured using the Beck Depression Inventory-II (BDI-II), BMI was objectively assessed, and physical performance was measured using the Fullerton Advanced Balance scale, 6-minute walk test, 30-second chair stand, and 8-foot up and go test. A path model using structural equation modeling yielded good fit and revealed that, compared to pain-free adult controls, participants with FM reported more depressive symptoms, which were in turn associated with reduced physical performance across all indicators except BMI, after adjusting for age and symptom severity. Findings suggest that individuals with FM demonstrate disproportionately higher depressive symptoms compared to non-FM controls, which may diminish physical performance after accounting for age and symptom severity. This study supports FM status and depressive symptoms as important considerations when evaluating the health and disability risk of aging adults.

The role of pain intensity and depressive symptoms in the relationship between sleep quality and postural control among middle-aged and older adults with Fibromyalgia.

OBJECTIVE: Fibromyalgia (FM) is a chronic pain condition often accompanied by sleep problems and depression that are each associated with reduced physical ability including postural control. Research supports a sequential association between pain intensity and depression in FM, and poor sleep quality may play a key role in this relationship. This study aimed to verify a serial pattern of associations among sleep quality, pain intensity, and depressive symptoms and quantify these effects on objective postural control. DESIGN: Community-residing adults diagnosed with FM (n = 155; Mage = 61.08, SD = 7.70; 93% female; 79% White) were included in this cross-sectional study. MAIN OUTCOMES: Participants self-rated sleep quality (restorative sleep, sleep waking, and sleep latency), pain intensity, and depressive symptoms, and the Fullerton Advanced Balance (FAB) scale and 8-Foot Up and Go Test (8FUPGT) measured objective postural control. RESULTS: Findings indicated that the serial association between pain intensity and depressive symptoms fully mediated the relationship between sleep quality and both FAB (95% CI [-.125, -.013]), and 8FUPGT (95% CI [.002, .033]) performance. CONCLUSION: Findings highlight the serial association of pain intensity and depressive symptoms with objective postural control performance and the potential for sleep and depression interventions that may maximize functional outcomes in FM.

Nurses' Perspectives of Their Impact While Serving on Boards.

OBJECTIVE: The study objective was to identify nurses' perceptions of their impact while serving on boards. BACKGROUND: Nurse leaders serving as voting board members are key experts for board effectiveness and may be associated with stronger performing organizations. Extant research indicates that nurse leaders are qualified for board service; however, no research explores the impact of nurses on boards. METHODS: We conducted an exploratory qualitative study by interviewing 20 nurses serving on boards. Hermeneutic analysis of the data resulted in 1 overarching pattern and 7 traversing themes. RESULTS: Nurses who serve on boards reported leveraging expert knowledge of healthcare and caring wisdom to influence strategic thinking to meet stakeholder needs. CONCLUSION: Nurses promote effective board governance by ensuring that the perspectives and needs of all stakeholders are represented in board processes. We recommend health-related organization executives and board leaders appoint nurses as voting members of their governing boards.

Pain intensity and physical performance among individuals with fibromyalgia in mid-to-late life: The influence of depressive symptoms.

This study investigated the mediating role of depressive symptoms among 147 middle-aged and older adults with FM in the relationship between pain intensity and 4 objective measures of physical performance: Fullerton Advanced Balance scale (FAB), 6-Minute Walk Test (6MWT), 30-Second Chair Stand (30SCS), and 8-Foot Up and Go Test (8FUPGT). Asymptotic mediation analyses revealed that depressive symptoms fully mediated the relationship between pain intensity and FAB (95% CI [-0.40, -0.10]) and 8FUPGT (CI [0.02, 0.11]) and partially mediated the relationship to 6MWT (CI [-9.15, -2.20]) and 30SCS (CI [-0.29, -0.06]). Findings support the evaluation of co-morbid depression in FM.

Distress as a mediator for pain and activities of daily living in older adults with fibromyalgia.

Introduction: Pain, distress, and activities of daily living impact the lives of those with chronic pain. This study investigated distress (depressive symptoms, anxiety) on the relationship between pain (intensity and pain interference) and activities of daily living in individuals with fibromyalgia while controlling for age. Methods: The current cross-sectional investigation focused on data from 123 men and women with fibromyalgia. Pain intensity, pain interference and anxiety were measured on 0-10 Likert type scales from the National Fibromyalgia Assessment Questionnaire. Depressive symptoms were assessed using the Beck Depression Inventory II. Activities of daily living (basic, instrumental) were measured with the Physical Activity Inventory Scale. Results: It was hypothesized that the relationships between pain intensity and pain interference and activities of daily living in individuals with fibromyalgia would be mediated by the construct of distress while controlling for age. Mediation significantly occurred in both models as predicted. However, those who were older reported lower levels of pain intensity and distress than their younger counterparts, which may be related to time since diagnosis or other factors. Discussion: Results of this study suggest that individuals with chronic pain conditions would benefit from treatment options which address distress, specifically depressive symptoms and anxiety.

Impact of Affect Balance on Cognitive and Physical Function in Adults With and Without Fibromyalgia.

OBJECTIVE: To identify the potential benefits of heightened levels of affect balance in older adults with and without chronic pain on various cognitive domains, physical performance, and perceived cognitive and physical health. METHOD: Ninety-one older adults, some with and some without fibromyalgia (FM) participated. Objective tests included cognitive (immediate and delayed recall, delayed recognition-CERAD 10-item word list) and physical measures (Fullerton Advanced Balance Scale; lower body strength-30-s chair stand; gait velocity-30-ft. walk). Self-report measures were problems with forgetting, activities of daily living (perceived function), and affect (Positive and Negative Affect Scale [PANAS]). Affect balance was calculated as positive minus negative affect from the PANAS. RESULTS: Hierarchical regression analyses revealed that-regardless of FM status-higher affect balance was associated with better episodic memory performance (immediate recall, delayed recognition), better balance, enhanced lower body strength (more chair stands), and healthier gait (30-ft. walk), as well as less forgetfulness and better perceived functional health. CONCLUSION: Increased affect balance was associated with better objective and subjective health in older adults both without and with chronic pain. Positive psychology treatments which increase affect balance are easy to administer, cost effective, and may add an important, additional treatment modality for maintaining health in normal aging adults as well as those with chronic pain. CLINICAL RELEVANCE: In order to help patients with healthy aging, nurses need to be aware of the potential long-term effect of emotional state on overall function and be able to counsel patients regarding potential treatments to enhance positive global emotions such as resilience.

Nurses Taking the Lead: A Look Back to Move Forward.

In recognition of the Year of the Nurse and Midwife, the 2020 annual conference of the Association for Leadership Science in Nursing (ALSN) celebrated A Look Back to Move Forward in recognition of the 50th anniversary of ALSN. The ALSN began as the Council of Graduate Education for Administrative Nursing (CGEAN) in 1970. Today, ALSN maintains the goals of shaping graduate education and research to inform nursing leadership practice.

Blood pressure as a predictor of everyday cognitive function in aging adults with and without fibromyalgia.

Objective : Both hypotension and hypertension are related to poorer cognitive performance in older adults. However, little attention has been paid to everyday problem solving, a real-world indicator of functionality and independence among aging individuals. Research also suggests that chronic pain may affect the relationship between blood pressure (BP) and cognition. This study examined the relationship between BP and everyday problem solving in older adults with and without fibromyalgia (FM), a chronic pain condition. Method : The study included 99 participants with an FM diagnosis (Mage = 59.95) and 88 healthy older adults (Mage = 68.01). Results : Multiple regression analyses revealed that systolic BP and pulse pressure, but not diastolic BP, were significant predictors of everyday problem solving after controlling for executive function. FM status did not moderate this relationship. Conclusion : These findings indicate that BP is an important factor in functional and cognitive health, especially among aging adults.

A Systematic Approach to Ventilator Management for the Pediatric Patient During Air Medical Transport.

OBJECTIVE: A checklist was developed to improve the ventilator management of pediatric patients for air medical transport with the aim of reducing the percentage of patients outside recommended parameters (no bag valve mask use, peripheral capillary oxygen saturation level > 90%, and end-tidal carbon dioxide level > 35 and < 50 mm Hg) from 41.3% to 20% within 7 months. METHODS: The checklist was developed based on recommended guidelines. After checklist orientation, its effectiveness was analyzed via chart review for inclusion criteria (> 5 kg and < 18 years) from July 2018 to January 2019. Parameters identified in the aim statement were used to evaluate effectiveness. After transport, a Likert survey concerning the value of the checklist was distributed. RESULTS: Significant improvements in pediatric ventilator management were noted when teams used the checklist. The rate outside of aim parameters was reduced significantly from 41.3% (n = 92, June 2012-May 2018 preintervention) to 10% (n = 20, July 2018-January 2019 postintervention) after the improvement action was implemented (χ2 = 7.01, P = .008). The 5-point Likert survey results (n = 38, 4.68 ± .57) supported teams' improved comfort after checklist implementation. CONCLUSION: The checklist improved ventilator management proficiency of pediatric patients and the comfort level of air medical teams providing care.

An Evaluation of Interprofessional Patient Navigation Services in High Utilizers at a County Tertiary Teaching Health System.

EXECUTIVE SUMMARY: The Affordable Care Act holds health systems accountable for patient outcomes. Patients with low socioeconomic status are at highest risk of lacking a primary care provider, receiving lower quality of care, and being readmitted. These patients also have elevated risks of all-cause readmissions and death after discharge. The purpose of this study was to determine if an interprofessional patient navigation program (PNP) decreases emergency department (ED) visits and hospital admissions for these high utilizers of care, thus promoting the implementation of PNPs in other healthcare settings. We performed a retrospective, single-centered, chart review of patients who were enrolled in the PNP. We compared utilization, including ED visits and hospital admissions, for patients two years prior to enrollment to their utilization after enrollment. We found significant reductions in hospital utilization through patient navigation in the predominantly indigent, culturally diverse population of high utilizers of the healthcare system. In addition, our investigation of costs associated with implementing a PNP indicates the potential for cost avoidance.

A Unique Strategy to Address Nurse Leader Fatigue.

A quality improvement process was implemented within a large, tertiary healthcare organization to develop and implement a roundtable culture as part of a fatigue risk management system focused on mitigating nurse leader fatigue and stress. Strategies to form trusting collaboration and reduce leader attrition were initiated and assessed for effectiveness. Results show measurable decreases in reported levels of stress and attrition. Acute, chronic, and persistent fatigue continue to challenge those in leadership roles.

Leveraging the Power of Board Leadership in Professional Nursing Organizations.

Nurses who aspire to lead a professional nursing organization can significantly influence the future of the nursing profession. This article describes 4 essential responsibilities required in a board leadership position as identified by a group of nurse leaders who have each served as the board president of a national or international professional nursing organization.

Using the Logic Model Framework to Standardize Quality and Rigor in the DNP Project.

BACKGROUND: Since the implementation of the DNP degree, there has been controversy, confusion, and inconsistency about the DNP project. To this day, the profession lacks a consensus of what the DNP project should be. PROBLEM: Despite much in the literature regarding these issues, there is no systematic approach to the development of DNP project guidelines. Consequently, there is now an escalating interest in increasing the quality and rigor of DNP projects. APPROACH: Many issues related to the DNP project can be addressed using a logic model approach and incorporating current best practices. CONCLUSIONS: This article demonstrates how a logic model can be used for the development or improvement of DNP project processes, incorporating best practices and evaluation methods to ensure quality and rigor.

Circle of Advisors: Creating a National Perspective for Graduate Curricula in Nursing Administration.

The CGEAN Board established a goal to support MSN administration programs to thrive and meet the need for well-prepared nurses to assume leadership roles. This column addresses how we embarked on this work through creation of a Circle of Advisors composed of national nursing leaders who came together to address specific curricular issues and more importantly to voice support for continuation of MSN administration programs.

Leading in the Healthcare Vortex.

The 2016 International Nursing Administration Research Conference, Leading in a Healthcare Vortex, was held in Orlando, Florida. The program drew 116 attendees with representation from Canada and Brazil. Participants from practice, education, and research discussed leadership in our turbulent healthcare climate, which are highlighted in this column. The conference was dedicated to the memory of Dr Heather S. Laschinger in recognition of her distinguished research legacy of empowering nursing work environments and mentorship of prominent nursing administration researchers.

Aging well: Processing speed inhibition and working memory related to balance and aerobic endurance.

AIM: The present study explored whether certain physical performance measures could be linked to specific cognitive domains in healthy older adults. METHOD: A total of 50 adults (mean age 69.5 years, SD 8.1) were evaluated on physical performance using measures of balance (Fullerton Advanced Balance Scale), functional mobility (8-ft up-and-go), lower body strength (30-s chair stand), gait (30-ft walk velocity) and aerobic endurance (6-min walk). Cognitive measures included Stroop Color-Word Test, Digit Span Backward, Trail Making Tests, Everyday Problems Test, Digit Symbol Substitution and a Brown-Peterson test. Principal component analyses reduced cognition to domains of processing speed, inhibition and working memory. RESULTS: Hierarchical regression analyses were carried out with age and each physical measure as potential predictors of the three cognitive domains. The balance scale and 6-min walk were specifically associated with processing speed, inhibition and working memory. CONCLUSIONS: Better dynamic balance and aerobic endurance predicted enhanced processing speed, inhibition and working memory in older adults, with these last two domains considered components of executive function. Geriatr Gerontol Int 2017; 17: 108-115.

Certified Nurse-Midwives' Experiences with Gestational Weight Management.

Excessive gestational weight gain is associated with fetal metabolic reprogramming and subsequent childhood obesity, as well as maternal recalcitrant obesity and its successive morbidities. We conducted a review of the literature and an explorative, descriptive study of the techniques and strategies used by a subset of certified nurse-midwives to help women achieve optimal gestational weight gain. We also identified barriers to this outcome. With more effective management approaches to gestational weight gain, adverse maternal and neonatal health outcomes could potentially be prevented. http://dx.doi.org/10.1016/j.nwh.2015.12.007.