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.

The Examination of Instrumental Activities of Daily Living and Perceived Adulthood in Emerging Adults.

Emerging adults differ in terms of the extent to which they perceive themselves as adults. We examined how the ability to perform activities related to independent living (i.e., instrumental activities of daily living [IADLs]) was associated with perceived adulthood. Data were collected from 236 emerging adults in college. Results suggested that IADL scores were positively related to perceived adulthood and achieved criteria of adulthood even after controlling for race, year in school, age, and sex. Results are discussed in terms of the development and importance of IADLs during emerging adulthood.

Novel Approaches to Teaching Aging and Disability: Active Learning Through Design and Exploration.

Active learning emphasizes student engagement and collaboration instead of more passive learning, which involves primarily listening to lectures in the classroom setting. The benefits of active learning are many with an emphasis on the expansion of higher-order processing and critical thinking skills. Active learning can be found in many best practice approaches in the Medicine, Science, Engineering, and Mathematics (MSTEM) fields. Hack-a-thon and hack events are examples of active learning. These are gaining popularity in research institutes, and specifically in engineering, computer science, business, and healthcare settings. Wikipedia defines hack-a-thon as the blending of the words "hack," referring to exploratory programming, and "marathon," referring to a timed event. This article describes a hack-a-thon approach for active learning in the classroom setting.

Health Communication With Same-Sex and Other-Sex Friends in Emerging Adulthood.

Objective We examined health-related communication between same-sex and other-sex friends and how communication was related to health-related behavior. Participants Data from 243 emerging adults attending college ( Mage = 18.96, SD = 1.43; 55.6% male) were analyzed. Methods Participants completed measures assessing the frequency in which they talked about and made plans to engage in exercise and nutrition-related behaviors with friends, as well as how often they engaged in exercise and nutrition-related behaviors. Results In general, participants reported more health-related communication with same-sex friends. Health-related communication with same-sex friends was positively related to health behaviors for men and women. However, the pattern of results differed for men and women depending on the topic of communication and the behavior being examined. Conclusion Our study extends the literature by examining the role of sex of friends in health communication and planning and how interactions with friends relate to health-promoting behavior.

Cognitive functioning throughout the treatment history of clinical late-life depression.

OBJECTIVE: Previous investigations into the relationship between late-life depressive symptoms and cognitive functioning have resulted in mixed findings concerning whether or not depressive symptoms and cognitive functioning are related. The mixed reports may be due in part to differences in clinical and nonclinical samples and to inadequate consideration of the dynamic nature (i.e., fluctuating course) of depressive symptoms and cognitive functioning in older adults. The current study examined the chronic, acute, and longitudinal relationships between depressive symptoms and cognitive functioning in older adults in an ongoing treatment study of major depressive disorder (MDD). METHODS: The neurocognitive outcomes of depression in the elderly study operates in a naturalistic treatment milieu using a pharmacological treatment algorithm and regular psychiatric assessment. Four hundred and fifty-three older adults [mean age 70 years, standard deviation (SD) = 7.2] meeting criteria for MDD at study enrollment received annual neuropsychological testing and depressive symptom monitoring for an average of 8.5 years (SD = 4.5). RESULTS: Hierarchical linear modeling revealed that higher age, lower education, and higher average/chronic levels of depressive symptoms were related to lower cognitive functioning. Additionally, results revealed that when an individual's depressive symptoms are higher than is typical for a specific individual, general cognitive function was worse than average. There was no evidence of lagged/longitudinal relationships between depressive symptoms and cognitive functioning in older adults in treatment for MDD. CONCLUSIONS: Cognitive functioning and depressive symptoms are concurrently associated in older adults with MDD, highlighting the potential importance for stabilizing mood symptoms as a means to manage cognitive deficits in late-life depression.

Are patients with knee osteoarthritis aware that platelet-rich plasma is a treatment option?

Osteoarthritis (OA) is a prevalent joint disease, particularly affecting the knees. This condition is often managed through various treatments, including intra-articular injections such as corticosteroids (CS), hyaluronic acid (HA), and platelet-rich plasma (PRP). PRP has shown promising outcomes in recent studies although it does lack strong endorsement in some clinical guidelines due to inconsistent results and lack of standardized results. This study was conducted to assess patient awareness and the frequency of PRP offered for the treatment of knee OA, compared to CS and HA. In a cross-sectional study, 46 knee OA patients were surveyed regarding their knowledge and experiences of CS, HA, and PRP injections. The questionnaires were administered between September 2022 and February 2023. Additionally, the study evaluated the severity of patients knee OA, using the Western Ontario and McMaster Universities Arthritis Index, and gathered demographic information from the participants. CS injections were offered to 93.5%, and 100% of participants had previously heard of this type of injection. HA injections were offered to 37%, and 65.9% of participants had heard of them. PRP was offered to 2%, and 6.5% had ever heard of it. This study underscores the limited awareness and utilization of PRP among knee OA patients. Patients and physicians need to be more informed of all of the treatment options available for knee OA, especially orthobiologics such as PRP. Future research in larger, diverse populations is needed.

Caring for the Unvaccinated During a Pandemic: Connecting Swanson's Theory of Caring.

Background and Purpose: Nurses frequently care for patients who make decisions against medical advice, a challenge that continues during and after the COVID-19 pandemic. This article explores U.S. nurses' experiences caring for unvaccinated COVID-19 patients and the resulting impacts using Swanson's Theory of Caring (STC). Methods: Data were gathered through an online survey collecting nurses' demographics, mental health screening data, and an open-ended question asking about a personal experience providing care to an unvaccinated COVID-19 patient. Researchers analyzed 128 responses using content analysis. STC served as the analytical framework. Results: Nurses' experiences were summarized into two main themes and four subthemes: (a) anger, frustration, fatigue, and resentment (24.2%) and (b) feeling a professional commitment to a nurse's duty (60.9%). Within the professional commitment theme, subthemes include the following: (a) patients can make an autonomous decision (15.6%); (b) feeling concerned for the patient (6.3%); (c) wanting to take action, educate, and vaccinate (29.7%); and (d) feeling moral conflict (9.3%). Results aligned with STC's five caring actions: knowing, doing for, being with, enabling, and maintaining belief. Implications for Practice: Nurses experienced emotional challenges caring for the unvaccinated during the pandemic resulting in psychological sequelae, including compassion fatigue and moral distress, in addition to positive outcomes of resilience and enhanced coping mechanisms. This study underscores the multifaceted nature of nurses' experiences and the emotional, ethical, and professional challenges they encountered when caring for unvaccinated COVID-19 patients. Nurse leaders should address these issues to enhance nurses' wellbeing and reduce compassion fatigue and dissatisfaction.

"I want to focus on something that I feel really good about every day": Career development in established adulthood.

In developed countries, education and career experimentation typically extends into people's twenties (Arnett, 2000, 2015; Mehta et al., 2020). Thus, people are not committing to a career path in which they can build expertise, take on increasing responsibilities, and climb an organizational ladder (Day et al., 2012) until they reach established adulthood, the period of development from 30 to 45. As the conceptualization of established adulthood is relatively new, little is known about career development during this period. As such, in the present study, we aimed to provide a better understanding of career development in established adulthood by interviewing participants (n = 100) aged 30-45 from across the United States about their career development. Some participants described Career Exploration in established adulthood, sharing how they were still searching for a good career fit, and how a sense of diminishing time related to how they explore career paths. Participants also described Career Stability in established adulthood, including feeling committed to a career path, noting that there were some drawbacks to this stability, but also benefits in terms of feeling confident in their roles. Finally, participants described Career Growth, and shared their experiences of climbing the career ladder as well as planning for the future and possible "second acts". Taken together, our results suggest that established adulthood, at least in the USA, brings some stability in terms of career paths and development but that it may also be a period of career reflection for some.

The relationship between perceived discrimination and coronary artery obstruction.

BACKGROUND: Chronic stressors such as perceived discrimination might underlie race disparities in cardiovascular disease. This study focused on the relationship between perceived discrimination and risk of severe coronary obstruction while also accounting for multiple psychosocial variables and clinical factors. METHODS: Data from 793 (629 white and 164 black) male veterans with positive nuclear imaging studies were analyzed. Participants were categorized as being at low/moderate or high risk for severe coronary obstruction based on results of their nuclear imaging studies. Hierarchical logistic regression models were tested separately for blacks and whites. The first step of the models included clinical factors. The second step included the psychosocial variables of optimism, religiosity, negative affect, and social support. The final step included perceived discrimination. RESULTS: Perceived discrimination was positively related to risk of severe obstruction among blacks but not among whites after controlling for clinical and psychosocial variables. Similar results were found in patients who underwent coronary angiography (n = 311). CONCLUSIONS: Perceived discrimination was associated with risk of severe coronary obstruction among black male veterans and could be an important target for future interventions.

Understanding within-group variability of everyday cognition in aging Black/African American adults: a mimic (multiple indicators, multiple causes) model approach.

UNLABELLED: BACKGROUND/STUDY CONTEXT: Everyday cognition represents the ability to solve problems within domains that are representative of issues faced by adults on a daily basis. The current study examined individual differences in everyday cognitive ability among aging Black/African American adults. METHODS: Demographic data on age, gender, education, physical functioning, chronic illnesses, self-reported health, and depression were collected from 248 African American adults (mean age = 67.8 years, standard deviation = 8.47 years). A multiple indicators, multiple causes (MIMIC) modeling approach was used to examine the associations of individual characteristics with latent everyday cognitive ability and composite score indicators. RESULTS: Age, depressive symptoms, and number of chronic illnesses were negatively related to latent everyday cognition. The individual characteristics of age, depressive symptoms, self-rated health, and education were directly associated with composite indicators of latent everyday cognition. This suggests that within this sample of older Black/African American adults that certain composite scores (i.e., telephone use, food preparation, and finances) may be particularly sensitive to these individual characteristics. CONCLUSION: These results identify specific sources of variability in everyday cognitive ability among aging Blacks/African Americans. These individual differences should be accounted for when studying everyday cognition among Blacks/African Americans and when comparing the everyday cognitive ability of Blacks/African Americans with other groups.

PTSD Symptoms and Functional Impairment among Nurses Treating COVID-19 Patients.

INTRODUCTION: Nurses providing direct care for patients with COVID-19 may be at particular risk for developing symptoms of post-traumatic stress disorder (PTSD). However, little is known about how these symptoms are related to workplace and non-workplace impairment. OBJECTIVE: We examined if PTSD symptoms mediated the relationship between treating patients with COVID-19 and functional impairment. METHODS: An online survey collected data regarding demographic and workplace variables, PTSD symptoms, functional impairment, distracted practice, and if the nurse treated patients with confirmed COVID-19. Data collected in November 2020 from 218 primarily White and female nurses were analyzed. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines in reporting the methods and results. RESULTS: Analyses involved two steps: (a) calculating descriptive statistics, conducting univariate tests, and examining correlations among study variables; and (b) conducting a path analysis examining the mediating role of PTSD symptoms in the relationship between treating patients with COVID-19 and functional outcomes. Univariate tests found that nurses who had a diploma/associate's/bachelor's and nurses who treated patients with COVID-19 reported more PTSD symptoms, functional impairment, and distracted practice compared to nurses with graduate degrees and those who did not treat patients with COVID-19. Compared to nurses who reported having access to adequate PPE, nurses who reported not having access to adequate PPE reported more PTSD symptoms but lower functional impairment and distracted practice. Men reported lower distracted practice scores than women. In step two of the analyses, the path model suggested that treating patients with COVID-19 was indirectly related to both distracted practice and functional impairment through PTSD symptoms. CONCLUSION: The probable PTSD symptoms and work- and non-work-related functional impairment of nurses working with patients with COVID-19 highlight the importance of developing interventions that help these essential workers address vulnerabilities associated with working during the COVID-19 pandemic.

Women do not shy away from competition: Competition in same-gender and cross-gender friendship dyads.

This study explored gender differences in competition within friendships of emerging adults. In a sample of 118 same and cross-gender friendship dyads, we used a quasi-experimental design to examine how people competed with friends and reacted to this competition when completing a task in both competitive and noncompetitive conditions. Using an Actor-Partner Interdependence Modeling approach to data analyses, we found that in the noncompetitive condition, men and women competed more with same-gender than with cross-gender friends. In the competitive condition, however, both men and women behaved more competitively with male than with female friends. Interestingly, while men reported more stress when competing with cross-gender friends, there was no difference in reported stress for women, regardless of the gender of the friend with whom they were competing. The findings indicate that both the specific and general social context in which competition occurs are important in determining whether gender differences are observed.

Subjective memory in older African Americans.

The current analysis examined (a) if measures of psychological well-being predict subjective memory, and (b) if subjective memory is consistent with actual memory. Five hundred seventy-nine older African Americans from the Baltimore Study of Black Aging completed measures assessing subjective memory, depressive symptomatology, perceived stress, locus of control, and verbal and working memory. Higher levels of perceived stress and greater externalized locus of control predicted poorer subjective memory, but subjective memory did not predict objective verbal or working memory. Results suggest that subjective memory is influenced by aspects of psychological well-being but is unrelated to objective memory in older African Americans.

Moderating Roles of Resilience and Social Support on Psychiatric and Practice Outcomes in Nurses Working During the COVID-19 Pandemic.

INTRODUCTION: Staff and equipment shortages and an easily transmissible virus make working in the COVID-19 pandemic demanding physically and psychologically. Nurses on the frontlines are particularly vulnerable to the adversity of working under these conditions, particularly with regard to mental health. Thus, understanding risk and protective factors for this vulnerable and essential group is critical for identifying potential targets of interventions. We had two aims for the current study: (a) to examine work functioning and symptoms of depression, anxiety, and posttraumatic stress (PTSD) among nurses who did and did not care for patients with COVID-19; and (b) to determine if resilience and social support moderate these relationships. METHODS: For three weeks in July 2020, nurses across the United States were invited to participate in an online survey collecting data on demographics, resilience, social support, and screening measures of depression, PTSD, anxiety, and distracted practice. Data were analyzed using descriptive statistics and hierarchical regression for each outcome measure. CONCLUSIONS: Our findings support a growing body of research reporting that nurses are experiencing mental health sequelae during the COVID-19 pandemic, especially those providing direct care to patients with the virus. We found that compared to nurses who did not care for patients with COVID-19, those who did reported increased symptoms of PTSD, depression, and anxiety. A novel contribution is our finding that nurses providing direct COVID-19 care also experienced increased levels of distracted practice, a behavioral measure of distraction linking to a potential impact on patient care. We also found that resilience and social support acted as moderators of some of these relationships. Fostering resilience and social support may help buffer the effects of providing care to patients with COVID-19 and could potentially decrease nurse vulnerability to developing psychological symptoms and impairment on the job.

"All of this was awful:" Exploring the experience of nurses caring for patients with COVID-19 in the United States.

INTRODUCTION: Little research documents the experience of nurses caring for patients with COVID-19 in the United States. This article explores the experience of nurses providing direct care to COVID-19 patients to understand the working conditions and emotional impact of working in this pandemic on nurses. METHODS: Data were gathered through an online survey distributed via snowball sampling in July 2020. The survey included an open-ended question asking nurses to describe a personal experience providing care to a COVID-19 patient. Researchers analyzed 118 responses using content analysis. RESULTS: The experience of nurses providing care to patients with COVID-19 was summarized into six themes: (1) feeling overwhelmed with the quantity of work (33.1%), (2) patient death (30.5%), (3) helplessness (23.7%), (4) absence of patient family presence and need for additional support (22.9%), (5) personal protective equipment (PPE) concerns regarding safety and how PPE can impair the nursing role (20.3%), and (6) lack of preparedness for the pandemic (16.9%). CONCLUSIONS: These findings suggest working directly with COVID-19 patients is a significant psychological strain on nurses. Adequate personal and institutional support for nurses is needed to prevent and treat mental distress from working under these conditions.

Race differences in cardiac catheterization: the role of social contextual variables.

BACKGROUND: Race differences in the receipt of invasive cardiac procedures are well-documented but the etiology remains poorly understood. OBJECTIVE: We examined how social contextual variables were related to race differences in the likelihood of receiving cardiac catheterization in a sample of veterans who were recommended to undergo the procedure by a physician. DESIGN: Prospective observational cohort study. PARTICIPANTS: A subsample from a study examining race disparities in cardiac catheterization of 48 Black/African American and 189 White veterans who were recommended by a physician to undergo cardiac catheterization. MEASURES: We assessed social contextual variables (e.g., knowing somebody who had the procedure, being encouraged by family or friends), clinical variables (e.g., hypertension, maximal medical therapy), and if participants received cardiac catheterization at any point during the study. KEY RESULTS: Blacks/African Americans were less likely to undergo cardiac catheterization compared to Whites even after controlling for age, education, and clinical variables (OR = 0.31; 95% CI, 0.13, 0.75). After controlling for demographic and clinical variables, three social contextual variables were significantly related to increased likelihood of receiving catheterization: knowing someone who had undergone the procedure (OR = 3.14; 95% CI, 1.70, 8.74), social support (OR = 2.05; 95% CI, 1.17, 2.78), and being encouraged by family to have procedure (OR = 1.45; 95% CI, 1.08, 1.90). After adding the social contextual variables, race was no longer significantly related to the likelihood of receiving catheterization, thus suggesting that social context plays an important role in the relationship between race and cardiac catheterization. CONCLUSIONS: Our results suggest that social contextual factors are related to the likelihood of receiving recommended care. In addition, accounting for these relationships attenuated the observed race disparities between Whites and Blacks/African Americans who were recommended to undergo cardiac catheterization by their physicians.

The moderating role of personality factors in the relationship between depression and neuropsychological functioning among older adults.

OBJECTIVE: Depression is often associated with decreased cognitive performance among older adults. The current study focused on the association of neuropsychological functioning and personality traits in depressed and non-depressed older adults. METHODS: Data from 75 depressed and 103 non-depressed adults over the age of 60 were analyzed. All participants underwent standardized clinical assessment for depression prior to participation and completed the NEO-PI-R and a series of neuropsychological assessments. RESULTS: A series of multiple linear regressions were conducted to examine the relationships between personality and neuropsychological performance among depressed and non-depressed older adults. Results indicated that higher Openness to Experience was related to better performance on Parts A and B of the Trail Making Test among depressed older adults, and to better Digit Span Backward performance among all participants. Higher levels of neuroticism were related to poorer performance on Digit Span Backward, but only among depressed older adults. Depressed participants performed more poorly on the Symbol Digit Modalities Test and the Controlled Oral Word Association Test. CONCLUSIONS: Personality characteristics, particularly Openness to Experience, modified the relationship between depression and neuropsychological functioning among older adults. Results indicate that interventions aimed at increasing one's Openness to Experience could potentially attenuate some of the neuropsychological impairments that are associated with depression.

Racial differences in hypertension knowledge: effects of differential item functioning.

Health-related knowledge is an important component in the self-management of chronic illnesses. The objective of this study was to more accurately assess racial differences in hypertension knowledge by using a latent variable modeling approach that controlled for sociodemographic factors and accounted for measurement issues in the assessment of hypertension knowledge. Cross-sectional data from 1,177 participants (45% African American; 35% female) were analyzed using a multiple indicator multiple causes (MIMIC) modeling approach. Available sociodemographic data included race, education, sex, financial status, and age. All participants completed six items on a hypertension knowledge questionnaire. Overall, the final model suggested that females, Whites, and patients with at least a high school diploma had higher latent knowledge scores than males, African Americans, and patients with less than a high school diploma, respectively. The model also detected differential item functioning (DIF) based on race for two of the items. Specifically, the error rate for African Americans was lower than would be expected given the lower level of latent knowledge on the items, on the questions related to: (a) the association between high blood pressure and kidney disease, and (b) the increased risk African Americans have for developing hypertension. Not accounting for DIF resulted in the difference between Whites and African Americans to be underestimated. These results are discussed in the context of the need for careful measurement of health-related constructs, and how measurement-related issues can result in an inaccurate estimation of racial differences in hypertension knowledge.