Influence of Neighborhood Disadvantage and Individual Sociodemographic Conditions on Heart Failure Self-care.

BACKGROUND: Residence in socioeconomically disadvantaged neighborhoods and individual sociodemographic conditions contribute to worse heart failure (HF) outcomes and may influence HF self-care. However, associations between neighborhood disadvantage, socioeconomic conditions, and HF self-care are unclear. OBJECTIVE: The purpose of this secondary analysis was to investigate whether neighborhood disadvantage and individual socioeconomic conditions predicted worse HF self-care. METHODS: This study was a secondary analysis of baseline data from a mixed-method study of 82 adults with HF. Participant zip codes were assigned a degree of neighborhood disadvantage using the Area Deprivation Index. Those in the top 20% most disadvantaged neighborhoods (Area Deprivation Index ≥ 80) were compared with those in the least disadvantaged neighborhoods. The Self-Care of Heart Failure Index was used to measure self-care maintenance and monitoring. Multiple linear regression was conducted. RESULTS: Of all participants, 59.8% were male, 59.8% were persons of color, and the mean age was 64.87 years. Residing in a disadvantaged neighborhood and living alone predicted worse HF self-care maintenance and monitoring. Having no college education was also a predictor of worse HF self-care maintenance. Although persons of color were more likely to reside in disadvantaged neighborhoods, race was not associated with HF self-care. CONCLUSION: Residing in a disadvantaged neighborhood and living alone may be important risk factors for worse HF self-care. Differences in self-care cannot be attributed solely to the individual sociodemographic determinants of race, gender, age, annual household income, or marital status. More research is needed to understand the connection between neighborhood disadvantage and HF self-care.

Gratitude Predicts Meaning in Life in Family Caregivers of Persons with Alzheimer's Disease.

Gratitude is a well-known and researched internal positive psychological resource. Empirical data, however, on the association between gratitude, meaning in life, and burden in family caregivers of persons with Alzheimer's disease is scant. The aims of this study were to (1) investigate the relationships among these variables in a sample of family caregivers of persons with Alzheimer's; and (2) determine if gratitude mediates the effects of perceived burden on meaning in life in this population. One-hundred and twenty-six adult family caregivers, most of whom were an intimate partner or adult child of a person with Alzheimer's, completed the Gratitude Questionnaire-Six Item, the Meaning in Life Questionnaire, the Zarit Burden Inventory, and other relevant measures. A series of OLS regression models, guided by the caregiver stress process model, were conducted. These analyses demonstrated that gratitude was a predictor of the presence of meaning in life among the caregivers in this study even when other key variables were considered. Furthermore, analyses revealed that gratitude fully mediated the effects of caregiver burden on the presence of meaning in life in this sample. Thus, clinicians should consider gratitude as an important internal resource for cultivating meaning in life in this population, especially when caregiver burden is present. Gratitude-bolstering clinical interventions should be further developed and tested as both stand-alone and complimentary additions to empirically supported psychoeducational approaches for supporting health and well-being in this population.

Hope Mediates Stress to Reduce Burden in Family Caregivers of Persons with Alzheimer's Disease.

The experience of burden among family caregivers of persons with Alzheimer's disease and other forms of dementia may be deleterious for their health and well-being. Little is known, however, about the degree to which internal positive psychological resources, such as hope, influence burden perceptions in this population. The current study is novel in that it examined how multiple dimensions of hope, hope-agency and hope-pathway, influenced burden in a sample of one-hundred and fifty-five family caregivers of persons with Alzheimer's disease. The stress process model was used as the theoretical framework for variable specification in this study. Hope was conceptualized using Snyder and colleagues' hope theory. Supporting our first hypothesis, we found that burden was negatively associated with hope-agency, r = -0.33, p < 0.001 and hope-pathway, r = -0.24, p < 0.01. Multiple regression was used to determine if hope-agency and hope-pathway independently contributed to burden. Analysis revealed that hope-agency but not hope-pathway influenced burden when other key variables were taken into consideration. Findings from mediation analysis affirmed that hope-agency had a small but significant mediation effect between stress and burden in this sample. This study provides evidence for the relevance of assessing multiple dimensions of hope when working with caregivers of persons with Alzheimer's. Although replication studies are warranted, the current study confirms a need for further development and refinement of hope-bolstering behavioral interventions which may mediate stress and burden in this population. These interventions should be systematically assessed for efficacy and effectiveness via implementation studies in real-world settings.

A sense of connectedness, transcendent experiences, and insights for compassionate action emerge through an international collective labyrinth walk with a shared intention during the COVID-19 pandemic.

Introduction: Labyrinth walking is an integrative contemplative practice that aims to engage the body, heart, mind, and spirit. In this article, qualitative findings from the first year of a mixed methods study on collective labyrinth walking with a shared intention are described. This form of labyrinth walking is distinct in that it is a social contemplative practice. It expands upon most of the labyrinth walking research to date which has been focused upon the individual. More specifically, practitioners walk labyrinths together in solidarity with the same intention in mind during collective labyrinth walking. This practice can be used locally (i.e. practitioners walk the same labyrinth together for the same reason) or non-locally (i.e. practitioners walk different labyrinths for the same reason together in different locations). The study is unique in that it took place at the height of the COVID-19 pandemic which was a time in recent history that evoked fear, uncertainty, grief, isolation, and disconnectedness for many persons around the world. Methods: This sample in this study was comprised of 461 participants from 19 countries who collectively walked labyrinths together with a shared intention on World Labyrinth Day 2021. Most participants were women in middle to later life from the United States. Data was collected through an anonymous online survey and analyzed using the qualitative methodology of interpretive phenomenological analysis. Results: Three predominant themes emerged from practitioners' narrative accounts of their lived experiences: (1) multiple forms of connectedness (i.e., intrapersonal, interpersonal, transpersonal, labyrinth connection) were cultivated through collective labyrinth walking with a shared intention; (2) practitioners reported qualities associated with "transcendent" experiences during this experience (i.e., boundlessness, ultimacy, transcendence, connectedness, positive emotions); and (3) practitioners had insights for compassionate action. Discussion: Findings suggest that collective labyrinth walking with a shared intention can contribute to individual and group flourishing during times of distress. Quasi-experimental and experimental research designs are needed to build on this exploratory developmental research and are described in this article.

We Have to Really Decide: The Childbearing Decisions of Women With Congenital Heart Disease.

BACKGROUND: Medical management and surgical improvement techniques permit persons with congenital heart conditions to live longer. Adults with congenital heart disease (CHD) have more childbearing options than previously available to them. However, there is an increased childbearing risk associated with certain types of CHD. Minimal investigation has been given to the childbearing decision-making experiences and adaptation of women with CHD. OBJECTIVE: The aim of this study was to gain insight into the childbearing decision-making and adaptation experiences of women with CHD. METHODS: Using a narrative inquiry approach, 17 adult women with CHD of any severity, of childbearing age, who had, within the last 5 years, made a decision regarding childbearing, were interviewed. In this study, we applied the key components of the Roy Adaptation Model to understand childbearing decision-making experiences and their adaptation. Data were analyzed using thematic analysis. RESULTS: Data analysis revealed 5 stages of childbearing decision making: (1) prologue: stimulus to consider childbearing; (2) exploring childbearing options; (3) considering childbearing options; (4) choosing to bear or not to bear a child; and (5) epilogue: adapting to the childbearing decision. Adaptation occurred in the areas of self-concept (ie, emotional adaptation), role function (ie, relational adaptation), and interdependence (ie, interactional adaptation). CONCLUSION: Childbearing decision making is a complex personal decision that is carefully and deliberately made. Women with CHD long for children and seek childbearing information from various resources and may experience grief regarding the inability to bear children. A greater understanding of childbearing decision making can be useful in addressing women's childbearing emotions and assist with adaptation to childbearing needs.

Resilience mediates the effects of self-care activation and hope on medication adherence in heart failure patients.

Medication adherence is important to heart failure (HF) self-care. However, the rate of medication nonadherence is approximately 50%. Evidence suggests that self-care activation and hope may be internal motivators for medication adherence. Empirical data on the association between self-care activation, hope, and medication adherence among people with HF is sparse, and the mechanism by which these factors influence medication adherence is unclear. The findings of prior research studies suggest that resilience may help to explain the relationship between self-care activation, hope, and medication adherence. The aim of this cross-sectional study was to investigate whether resilience mediated the effects of self-care activation and hope on medication adherence. A total of 174 adults with HF, between the ages of 19 and 92, completed the Patient Activation Measure, The Adult Hope Scale, the 14-item Resilience Scale, and the Domains of Subject Extent of Nonadherence Scale. Mediation analyses revealed that resilience fully mediated the effects of self-care activation and hope on medication adherence. Clinicians should consider the person related factors of self-care activation, hope, and resilience when promoting medication adherence in people with HF. Resilience may play an important role in improving medication adherence in HF patients. More research is needed to understand the connection between resilience, self-care activation, hope, and medication adherence.

A qualitative analysis of virtues and strengths in persons living with early stage dementia informed by the values in action framework.

BACKGROUND: Despite evidence that individuals' virtues and character strengths can contribute to a sense of fulfillment, the majority of dementia research focuses on losses and decline. To date, virtues and character strengths in persons living with dementia is an understudied phenomena. This study begins to addresses this gap in the literature. OBJECTIVES: The objectives of this study were to: (1) examine the expression of virtues and character strengths in persons living with dementia in the early stages; and (2) share implications and recommendations for strengths-based clinical practice and future research. METHODS: Qualitative data was utilized to examine virtues and character strengths among persons living with dementia. This data was derived from semi-structured interviews with 25 persons living with dementia age 65 or older (average age of 77.88). The interviews were audio recorded with consent, professionally transcribed, audit checked, and subjected to Interpretive Phenomenological analysis which was informed by the Values in Action (VIA) framework. FINDINGS: Each of the virtues and 24 corresponding character strengths from the VIA framework were observed in this sample. The most frequently observed character strengths were love, spirituality, perseverance, and gratitude. IMPLICATIONS: Persons with dementia continue to express virtues and character strengths in the context of cognitive and functional changes. Positive strengths-based research and clinical practice should highlight and build upon these individual virtues and character strengths.

Applying Stress and Coping Theory to Understand Diuretic Adherence Experiences in Persons with Heart Failure.

Despite the benefits of diuretics for treating the symptoms of heart failure (HF), patients may report side effects and intentionally not adhere to diuretic regimens. Positive internal motivators, such as positive emotions, may benefit individuals in their adaptation to medication-related stress. However, there has been limited study of these potential motivators in those with HF. Using a descriptive qualitative approach, 82 adults taking diuretics for HF were interviewed. This study applied stress and coping theory to understand the diuretic-taking experiences of patients with HF. Data analysis revealed three themes: (a) diuretics are bothersome, (b) staying positive in the mid of hardship, and (c) adapting to endure. Findings suggest that adherent participants stayed positive amid the perceived hardship, maintaining resilient and grateful attitudes. Adherent participants adapted to bothersome diuretic effects and utilized creative strategies. More research is needed to understand the relationships between resilience, adaptive coping, and diuretic adherence.

The Impact of Resilience, Health Literacy, and Social Support on Medication Adherence and Self-care Among Adults With Heart Failure.

BACKGROUND: Personal and psychological factors, such as depression, have a considerable influence on nonadherence to medications and self-care in those with heart failure. More evidence is needed about positive personal factors that motivate adherence to medications and self-care in those with heart failure. OBJECTIVE: The purpose of this study was to investigate whether there was a relationship between the personal resources of resilience, hope, health literacy, social support, and self-care activation and adherence to HF self-care and medications and whether race impacts adherence. METHODS: This study used a cross-sectional, correlational design. Stepwise regression was used to test whether resilience, hope, health literacy, self-care activation, and race significantly predicted medication adherence and self-care. A diverse sample was recruited for this study. RESULTS: Of the 174 participants, 51% were female, 51.7% were White, and the mean age was 62 years. After adjustment for differences in age and depressive symptoms, a predictive relationship remained between resilience, health literacy, and medication adherence. Hope, activation, and race were not selected in the final regression model. A high level of perceived social support was the only predictor of better HF self-care. CONCLUSION: Persons with heart failure may have better medication adherence and overall self-care if sufficiently resilient, health literate, and supported regardless of their degree of hope or activation. Race and age may be important factors to consider. More research is needed to understand the connection between resilience and medication adherence.

Medication Nonadherence or Self-care? Understanding the Medication Decision-Making Process and Experiences of Older Adults With Heart Failure.

BACKGROUND: More than half of all patients with heart failure (HF) do not take medications as prescribed, resulting in negative health outcomes. Research has shown that medication adherence may be intentional rather than the ability to follow prescribed regimens, yet very little is known about medication-taking decisions in older patients with HF. OBJECTIVE: The purpose of this qualitative study was to gain insight into the decision-making processes and experiences of older patients with HF by exploring the different aspects in choosing to take or not take medications as prescribed in the community setting. METHODS: Using a narrative inquiry approach, the personal narratives of 11 adults 65 years or older who took at least 2 daily medications for HF were gathered using in-depth, semistructured interviews. The data in this study were organized and analyzed using Riessman's framework for narrative analysis. RESULTS: Participants made intentional decisions to take particular medications differently than prescribed. A worrisome symptom prompted a naturalistic decision-making process. When a medication interfered with attaining a personal goal, participants coped by individualizing their medication regimen. Participants did not consider taking a medication differently than prescribed as nonadherence but a necessary aspect of maintaining a personal level of health, which could be seen as self-care. CONCLUSIONS: The older patient with HF should be carefully assessed for nonadherence. The development of interventions that are patient specific, target medications with the greatest potential for nonadherence, and use easy-to-access resources may promote decisions for medication adherence. More research is needed to develop interventions that promote decisions for medication adherence.

Homeless No More: A Christ-Centered, Comprehensive Homeless Recovery Program.

Caring for vulnerable and marginalized populations is a central tenet of professional nursing, and of Christian service. Due to the scope and complexities of problems associated with homelessness, nurses may feel overwhelmed and ill-equipped to serve homeless individuals. Strategies for ending homelessness largely include resource-intensive, publicly supported housing and comprehensive physical and mental health services. The role of spirituality in recovery from homelessness has not been widely examined. This article describes one homeless shelter's successful Christ-centered, comprehensive approach to helping individuals recover from homelessness. The integral role of the nurse in the multidisciplinary team and practical nursing interventions are described.

Development of an Online Data Applications Course Using an Interprofessional Education Model.

Development of a data applications course with an interdisciplinary focus presented challenges for nurses participating in the design of a post-master's certificate program in informatics. In this article, we describe our use of an interprofessional education model to create the course and discuss our experiences in teaching the course for the first time. We identify our challenges and plan to address them in future semesters.