Social Safety for Black Women in Perinatal Health Care: A Concept Analysis.

INTRODUCTION: Non-Hispanic Black women and their infants experience the worst pregnancy-related outcomes in the United States. Social safety is a health-relevant resource found in environments communicating safety, connectedness, inclusion, and protection. Approaches promoting social safety may be particularly relevant to preventing adverse perinatal health outcomes among Black women. However, there remains a lack of conceptual clarity. The purpose of this concept analysis was to provide a theoretical clarification of the concept social safety for Black women within perinatal health care. METHODS: PubMed, PsycINFO, and CINAHL were searched using Boolean search strategy. Retrieved articles were managed in Zotero. Duplicates were removed, and each article was assessed and categorized by both investigators. Articles reporting Black women's perinatal health care experiences were included. Thematic analysis guided by Rodgers' evolutionary method identified defining attributes, antecedents, and consequences of social safety in perinatal care for Black women. RESULTS: Social safety for Black women is defined as the process of feeling understood, respected, cared for, and in control in perinatal health care settings that make space, care for, and recognize strengths, thereby cultivating safety and empowerment. DISCUSSION: Social safety offers actionable insights for practice and research that have the potential to drive positive change in perinatal care delivery for Black women. Developing interventions and measurements that are valid, reliable, and reflect social safety are essential to promote positive experiences and equity in health care practices and policies.

Socially-supported sleep in older adults aged 50 and older: a concept analysis.

Introduction: The population of older adults is growing disproportionately, constituting 13% of the global population in 2022, and is expected to double by 2050. One of public health's priorities is healthy aging, the maintenance of functional ability aligned with well-being. As many as 50% of older adults report poor sleep quality, leading to an increased risk of morbidity and mortality. The quality and quantity of social relationships may broadly benefit sleep in older adults. However, the concept of socially-supported sleep is underdeveloped as a basis for intervention. Methods: Existing literature was searched without time restriction in PubMed, CINAHL, PsycINFO, and Scopus ending in August 2022. Thematic analysis was used to determine the defining attributes, antecedents, and consequences of socially-supported sleep guided by Rodgers' evolutionary concept analysis. Results: Twenty-nine articles written in English, peer-reviewed, and examined social support and sleep in participants aged ≥50 were included. The defining attributes reflect dimensions of sleep quality. The antecedents are safe and secure, belonging and connection, and warmth and comfort. The consequences of socially-supported sleep include improved regulatory capabilities, physical and emotional well-being, and quality of life. Conclusion: Socially-supported sleep has the potential to inform interventions that promote sleep in older adults. Ongoing research is needed to address the antecedents and mechanisms through which socially-supported sleep may promote sleep quality for healthy aging.

Behavioral activation for family caregiver connectedness: Adaptation of an evidenced based intervention.

Informal caregivers of older adults with chronic illness have unique barriers to social connection. As the older adult population increases, individualized interventions are urgently needed to address the social disconnection experienced across generations of informal caregivers. Adapting an evidenced-based intervention to target social connectedness and leverage technology-mediated communication may be a promising approach. This article describes the adaptation of the Brief Behavioral Activation Treatment for Depression-Revised intervention using elements of the Framework for Reporting Adaptations and Modifications-Enhanced. Facilitating the comprehensive documentation of modifications made, we discuss the (a) rationale for modifications, (b) timing and approach to modifications, (c) nature of context and content modifications, and (d) fidelity in modifications. The Behavioral Activation for Family Caregiver Connectedness intervention addresses unique barriers to caregiver social connection with individualized value-based plans. Modifications to content and delivery reflect the goal of improving intervention fit in the context of social connectedness experienced by informal caregivers.

Feeling Safe and Nostalgia in Healthy Aging.

The population of older adults worldwide is growing, with an urgent need for approaches that develop and maintain intrinsic capacity consistent with healthy aging. Theory and empirical research converge on feeling safe as central to healthy aging. However, there has been limited attention to resources that cultivate feeling safe to support healthy aging. Nostalgia, "a sentimental longing for one's past," is established as a source of comfort in response to social threat, existential threat, and self-threat. Drawing from extant theory and research, we build on these findings to position nostalgia as a regulatory resource that cultivates feeling safe and contributes to intrinsic capacity to support healthy aging. Using a narrative review method, we: (a) characterize feeling safe as a distinct affective dimension, (b) summarize the character of nostalgia in alignment with feeling safe, (c) propose a theoretical account of the mechanisms through which nostalgia cultivates feeling safe, (d) highlight the contribution of nostalgia to feeling safe and emotional, physiological, and behavioral regulatory capabilities in healthy aging, and (e) offer conclusions and direction for research.

Pilot randomized controlled trial of the Yoga for HEART intervention in community-dwelling older adults.

Physical activity reduces cardiovascular risk; however, many older adults do not engage in recommended levels. Theory-based interventions supporting motivation for physical activity are limited. This pilot study evaluated the feasibility of Yoga for Health Empowerment and Realizing Transformation (HEART), a theory-based intervention combining motivation and yoga-based physical activity. Feasibility was addressed as acceptability, demand, implementation fidelity, and limited efficacy in promoting physical activity, cardiovascular health, and mechanisms of action. Sedentary older adults (m = 65 years old, sd = 8.5) were randomized to Yoga for HEART (n=8) or Active Control (n=7) conditions. Yoga for HEART was: (a) acceptable, (b) retention 73%, (c) implemented as planned. A significant main effect for body mass index (BMI) was found in Yoga for HEART participants (p = .02). No significant effects were found for physical activity, other cardiovascular outcomes, or mechanisms of action. Yoga for HEART is feasible and recommended for further testing.

Health Empowerment in Older Adult Informal Caregivers✰.

BACKGROUND: The need to support informal caregivers is among the most overlooked challenges facing the aging population, their families, and society. Understanding the experience of well-being and resources contributing to well-being among older caregivers is essential. OBJECTIVE: The purpose of this research was to explore personal strengths, social contextual resources, and the power to choose and pursue valued objectives central to well-being among older caregivers. This research was theoretically informed by the Health Empowerment Theory. METHODS: Qualitative descriptive design addressed research objectives. Purposive sampling included recruitment and interviews with twenty-one older adult caregivers. Qualitative content analysis identified distinct categories and themes of meaning and supported trustworthiness. RESULTS: Categories supported and extended Health Empowerment Theory among older caregivers, reflecting unique strengths, resources, and growth consistent with valued objectives, fostering well-being. DISCUSSION: Findings further understanding of the ways in which caregivers move toward well-being within the context of complexity and change.

Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association.

As clinicians delivering health care, we are very good at treating disease but often not as good at treating the person. The focus of our attention has been on the specific physical condition rather than the patient as a whole. Less attention has been given to psychological health and how that can contribute to physical health and disease. However, there is now an increasing appreciation of how psychological health can contribute not only in a negative way to cardiovascular disease (CVD) but also in a positive way to better cardiovascular health and reduced cardiovascular risk. This American Heart Association scientific statement was commissioned to evaluate, synthesize, and summarize for the health care community knowledge to date on the relationship between psychological health and cardiovascular health and disease and to suggest simple steps to screen for, and ultimately improve, the psychological health of patients with and at risk for CVD. Based on current study data, the following statements can be made: There are good data showing clear associations between psychological health and CVD and risk; there is increasing evidence that psychological health may be causally linked to biological processes and behaviors that contribute to and cause CVD; the preponderance of data suggest that interventions to improve psychological health can have a beneficial impact on cardiovascular health; simple screening measures can be used by health care providers for patients with or at risk for CVD to assess psychological health status; and consideration of psychological health is advisable in the evaluation and management of patients with or at risk for CVD.

Development of a Nostalgic Remembering Intervention: Feeling Safe in Dyads Receiving Palliative Care for Advanced Heart Failure.

BACKGROUND: Dyads receiving palliative care for advanced heart failure are at risk for the loss of feeling safe, experienced as a fractured sense of coherence, discontinuity in sense of self and relationships, and strained social connections and altered roles. However, few theory-based interventions have addressed feeling safe in this vulnerable population. PURPOSE: The purpose of this article is to describe the development of the Nostalgic Remembering Intervention to strengthen feeling safe and promote adaptive physiological and psychological regulation in dyads receiving palliative care for heart failure. CONCLUSIONS: Systematic intervention development is essential to understand what, for whom, why, and how an intervention works in producing outcomes. Program theory provided a systematic approach to the development of the Nostalgic Remembering Intervention, including conceptualization of the problem targeted by the intervention, specification of critical inputs and conditions that operationalize the intervention, and understanding the mediating processes leading to expected outcomes. CLINICAL IMPLICATIONS: Creating a foundation for cardiovascular nursing research and practice requires continued, systematic development of theory-based interventions to best meet the needs of dyads receiving palliative care for heart failure. The development of the Nostalgic Remembering Intervention to strengthen feeling safe in dyads provides a novel and relevant approach.

Feasibility Study of the Health Empowerment Intervention in Older Adults With Heart Failure.

BACKGROUND: Of almost 5.7 million Americans with heart failure, 80% are 65 years and older. Empowerment approaches facilitating recognition of personal and social contextual resources may improve well-being in this vulnerable population. OBJECTIVE: This research evaluated the feasibility of the Health Empowerment Intervention (HEI) in older adults with heart failure, including effects on health empowerment, purposeful participation, self-management, functional health, and well-being. METHODS: Twenty older adults with heart failure were randomly assigned to HEI or Attention Control conditions. The HEI consisted of 6 weekly sessions based on the Health Empowerment Theory. Outcomes were measured at baseline and at 6 weeks. RESULTS: Feasibility of the HEI was supported; participants realized significant improvement in health empowerment and purposeful participation in goal attainment.ConclusionsThis research supports the feasibility of the HEI and provides a basis for continued evaluation.

ReadySteady intervention to promote physical activity in older adults with Parkinson's disease: Study design and methods.

The main motor impairments of gait and balance experienced by people with Parkinson's disease (PD) contribute to a sedentary lifestyle, resulting in poor physical conditioning, loss of functional independence, and reduced quality of life. Despite the known benefits of physical activity in PD, the majority of older adults with PD are insufficiently active. Few studies incorporate behavioral change approaches to promoting physical activity in PD. The main goal of this research is to foster community mobility in older adults with PD by promoting physical activity and improving gait patterns using a theory-based behavioral change intervention. The ReadySteady intervention combines wellness motivation theory with polestriding physical activity, which has been shown to be beneficial for people with PD. The intervention will be tested using a randomized controlled design, including inactive older adults diagnosed with PD. Participants will be randomly assigned the 12-week ReadySteady intervention, 12-week polestriding, and education intervention, or 12-week education intervention. Thirty-six older adults with PD will participate in each of the interventions. Level of physical activity, clinical scores, quantitative measures of gait and balance control, and motivational variables for each intervention will be measured at three time points: pre-intervention, post-intervention (12 weeks), and follow-up (24 weeks). If the intervention is beneficial, it may serve as a sustainable addition to current practice in health promotion efforts serving the PD population.

Music intervention to prevent delirium among older patients admitted to a trauma intensive care unit and a trauma orthopaedic unit.

PURPOSE: Evaluate music listening for delirium prevention among patients admitted to a Trauma Intensive Care and Trauma Orthopaedic Unit. The Roy Adaptation Model provided the theoretical framework focusing on modifying contextual stimuli. METHODS: Randomised controlled trial, 40 patients aged 55 and older. INTERVENTION: Participants randomly assigned to receive music listening or usual care for 60 minutes, twice a day, over three days. Pre-recorded self-selected music using an iPod and headsets, with slow tempo, low pitch and simple repetitive rhythms to alter physiologic responses. OUTCOMES: Heart rate, respiratory rate, systolic and diastolic blood pressure, confusion assessment method. RESULTS: Repeated measures ANOVA, F(4, 134) = 4.75, p = .001, suggested statistically significant differences in heart rate pre/post music listening, and F(1, 37) = 10.44, p = .003 in systolic blood pressure pre/post music listening. Post-hoc analysis reported changes at three time periods of statistical significance; (p = .010), (p = .005) and (p = .039) and a change in systolic blood pressure pre/post music listening; (p = .001) of statistical significance. All participants screened negative for delirium. CONCLUSION: Music addresses pathophysiologic mechanisms that contribute to delirium; neurotransmitter imbalance, inflammation and acute physiologic stressors. Music to prevent delirium is one of few that provide support in a critical care setting.

Using a Cultural Framework to Assess Motivation for Physical Activity Among Older Hispanic Women: Application of the PEN-3 Model.

Culturally relevant strategies for intervention design and implementation, emphasizing strengths and resources, are essential to address cardiovascular health disparities among older Hispanic women. The purpose of this article is to present the process and results of focus group discussions conducted to understand the meaning of cultural, social, and contextual strengths to promote motivation for physical activity and cardiovascular health in this population. The PEN-3 model guided analysis of focus group data. Fifteen older Hispanic women (mean = 61, SD = 6) participated in 3 focus groups. Three interrelated domains were evaluated: (a) cultural identity, (b) relationships and expectations, and

Environmental Resources in Maintenance of Physical Activity 6 Months Following Cardiac Rehabilitation.

This study examined differences in weekly time spent in physical activity by level of perceived environmental resources, 6 months following graduation from cardiac rehabilitation. A descriptive, longitudinal design used standardized measures to evaluate perceived environmental resources and physical activity levels. Repeated measures analysis of variance was used to examine mean differences in weekly time spent in physical activity by level of perceived environmental resources. Adults 51 to 86 years old (N = 150) diagnosed with coronary heart disease were included. There was a significant change over time in physical activity as measured by minutes per week, F(2, 148) = 7.915, p = .001, where activity increased between baseline and 3 months, and then dropped slightly at 6 months. This change over time differed by the level of perceived neighborhood resources, F(2, 148) = 3.545, p = .032. Home and neighborhood resources may positively influence physical activity maintenance following cardiac rehabilitation.

Combining Motivational and Physical Intervention Components to Promote Fall-Reducing Physical Activity Among Community-Dwelling Older Adults: A Feasibility Study.

PURPOSE: To assess the feasibility of a new intervention, Ready~Steady, in terms of demand, acceptability, implementation, and limited efficacy. DESIGN: Randomized controlled trial; repeated measures. SETTING: Two rural communities in Itasca County, Minnesota. SUBJECTS: Thirty participants were randomized to an intervention (n = 16) or attention-control (n = 14) group. INTERVENTION: Ready~Steady combined two components: (1) motivational (motivational support, social network support, empowering education), and (2) fall-reducing physical activities (PAs; guidance to practice leg-strengthening, balance, and flexibility activities and walking). MEASURES: Acceptability questionnaire and Indices of Procedural Consistency (investigator developed), Community Health Activity Model Program for Seniors Questionnaire (confirmed with accelerometry), Short Physical Performance Battery, Perceived Environmental Support Scale, Social Support for Exercise Questionnaire, Goal Attainment Scale, Index of Readiness, and Index of Self-Regulation. ANALYSIS: Descriptive statistics and a marginal approach to repeated-measures analysis of variance, using mixed-model procedures. RESULTS: Attrition was 7% and mean attendance was 7.2 of 8 sessions, participants evaluated Ready~Steady as acceptable, and implementation fidelity was good. The intervention group improved significantly more than the attention-control group in PA behavior, F1,27 = 11.92, p = .002; fall risk (functional balance and strength), F1,27 = 14.89, p = .001; support for exercise from friends, F1,27 = 11.44, p = .002; and self-regulation, F1,26 = 38.82, p < .005. CONCLUSION: The Ready~Steady intervention was feasible as evidenced by low attrition and good attendance and implementation, as well as positive effects on targeted outcomes and theoretical mechanisms of change.

Systematic Review of Yoga Interventions to Promote Cardiovascular Health in Older Adults.

The benefits of physical activity are well established, yet few older adults engage in adequate physical activity to optimize health. While yoga may reduce the risk of cardiovascular disease, few studies have focused on the efficacy of yoga-based physical activity to promote cardiovascular health in older adults. The objective of this review is to provide an evaluation of yoga interventions to reduce cardiovascular risk in older adults. Four databases were searched for randomized controlled trials of yoga interventions in older adults. Studies with cardiovascular outcomes were included. Literature searches identified nine articles eligible for review. Significant health benefits were reported, including favorable changes in blood pressure, body composition, glucose, and lipids. Yoga practices, participant characteristics, and outcome measures were variable. There was limited use of theory. Yoga is safe and feasible in older adults; additional research is warranted to examine the specific components of yoga interventions essential to reducing cardiovascular risk.

Optimal Health (Spirit, Mind, and Body): A Feasibility Study Promoting Well-Being for Health Behavior Change.

Faith-based programs have shown beneficial effects for health and behaviors. Few have specifically intervened on the spiritual, mental (i.e., stress), and physical dimensions of well-being combined for health and healthy behaviors (i.e., exercise and diet). The purpose of this report is to describe the feasibility of executing a spirituality-based health behavior change, program founded upon the Spiritual Framework of Coping. This study was a quasi-experimental one group pretest-posttest design. Feasibility objectives were assessed, and limited efficacy of pretest and posttest measures was analyzed using paired t test (p < .05). Acceptance of the program was positive, and modest demand was shown with initial interest and an average attendance of 78.7%. The program was successfully implemented as shown by meeting session objectives and 88% homework completion. The program was practical for the intended participants and was successfully integrated within the existing environment. Limited efficacy measures showed no pre-post changes. This study provided preliminary support for the design and further testing of the theoretical components of the Spiritual Framework of Coping that informed the program.

Design and evaluation of theory-informed technology to augment a wellness motivation intervention.

Integrating mobile technology into health promotion strategies has the potential to support healthy behaviors. A new theory-informed app was designed to augment an intervention promoting wellness motivation in older adults with fall risk and low levels of physical activity. The app content was evaluated for clarity, homogeneity, and validity of motivational messages; both the app and device were evaluated for acceptability and usability. The initial evaluation included nine adults (mean age, 75); four of whom also assessed the app's sensing abilities in the field. As part of an intervention feasibility study, 14 older adults (mean age, 84) also provided a follow-up evaluation of app usability. Evaluation participants assessed the app as valid, usable, acceptable, and able to sense most reported free-living activities, and provided feedback for improving the app. Design processes illustrate methodologic and interpretive efforts to operationalize motivational content in a theory-informed app promoting change in physical activity behavior.

A Motivational Physical Activity Intervention for Improving Mobility in Older Korean Americans.

There has been limited empirical support for interventions designed to promote physical activity targeting mobility in racially diverse older adults. This study aims to examine the effects of a Motivational Physical Activity Intervention (MPAI) on social resource, behavioral change process, physical activity, and mobility variables in sedentary older Korean Americans. A quasi-experimental, repeated-measure, pre- and post-tests design was used. Sixty-four community-dwelling, sedentary older Korean Americans (n = 33 for MPAI group, n = 31 for Attention Control group) participated in the study. There were significant improvements in social resources, including social support from family and friends; behavioral change process variables, including self-efficacy; motivational appraisal; and self-regulation for physical activity. There were significant intervention effects on physical activity, walking endurance, and flexibility. The MPAI is supported as improving mobility and physical activity, as well as increasing motivation for physical activity in older Korean Americans.

Effects of a physical activity and healthy eating intervention to reduce stroke risk factors in older adults.

OBJECTIVE: To evaluate the effects of a theory-based physical activity and healthy eating intervention aimed at reducing stroke risk factors among overweight/obese and sedentary older adults. METHODS: Between 12/2009-1/2011, participants (n=69) were randomly assigned to an 8-week group motivational intervention or biweekly newsletters by mail. Physical activity (blinded pedometer, 7-day recall) body composition, theoretical mediator, and dietary (24-hour recall) variables were measured at pre-test and post-test. The physical activity and dietary outcomes are reported. RESULTS: For outcome measures, the follow-up was 90% for the intervention group (n=29) and 91% for the control group (n=34) for this sample. Statistically significant differences in the 7-day physical activity self-report were noted at post-test in the intervention group. The dietary measures were not statistically significant at post-test; however, the intervention group increased the quantity of vegetable servings. CONCLUSION: Limited efficacy testing was supported for a combined physical activity-dietary intervention, framed by a wellness-motivation theory, and designed to reduce stroke risk factors in older adults who are sedentary and overweight/obese. Limitations were identified and recommendations for additional research provided.

Mobile computer application for promoting physical activity.

Despite evidence that physical activity reduces the risk of falls and other causes of disability and death, the majority of older adults do not engage in physical activity on a regular basis. Mobile technology applications have emerged as potential resources for promoting physical activity behavior. This article describes features of a new application, Ready∼Steady, highlighting approaches used in its design and development, and implications for clinical practice. Iterative processes enabled the design, development, implementation, and evaluation of the application consistent with the wellness motivation theory, as well as established user-specific strategies and theoretical design principles. Implications in terms of potential benefits and constraints are discussed. Integrating technology that promotes health and wellness in the form of mobile computer applications is a promising adjunct to nursing practice.