Search

Background: The transition to spontaneous breathing puts patients who are undergoing ventilator withdrawal at high risk for developing respiratory distress. A patient-centered algorithmic approach could standardize this process and meet unique patient needs because a single approach (weaning vs. one-step extubation) does not capture the needs of a heterogenous population undergoing this palliative procedure. Objectives: (1) Demonstrate that the algorithmic approach can be effective to ensure greater patient respiratory comfort compared to usual care; (2) determine differences in opioid or benzodiazepine use; (3) predict factors associated with duration of survival. Design/Settings/Measures: A stepped-wedge cluster randomized design at five sites was used. Sites crossed over to the algorithm in random order after usual care data were obtained. Patient comfort was measured with the Respiratory Distress Observation Scale© (RDOS) at baseline, at ventilator off, and every 15-minutes for an hour. Parenteral morphine and lorazepam equivalents from the onset of the process until patient death were calculated. Results: Usual care data n = 120, algorithm data n = 48. Gender and race were evenly distributed. All patients in the usual care arm underwent a one-step ventilator cessation; 58% of patients in the algorithm arm were weaned over an average of 18 ± 27 minutes as prescribed in the algorithm. Patients had significantly less respiratory distress in the intervention arm (F = 10.41, p = 0.0013, effective size [es] = 0.49). More opioids (t = −2.30, p = 0.023) and benzodiazepines (t = −2.08, p = 0.040) were given in the control arm. Conclusions: The algorithm was effective in ensuring patient respiratory comfort. Surprisingly, more medication was given in the usual care arm; however, less may be needed when distress is objectively measured (RDOS), and treatment is initiated as soon as distress develops as in the algorithm. Clinical Trial Registration number: NCT 03121391. [ABSTRACT FROM AUTHOR]

Women in the US Virgin Islands (USVI) experience intimate partner violence (IPV) and human immunodeficiency virus (HIV) at disproportionate rates compared to women on the US mainland. Women in violent relationships report experiencing controlling behaviours that decrease their ability to negotiate for sex using condoms or to prevent unwanted pregnancies. Though several evidence-based interventions exist to prevent either IPV or HIV, few address them through an integrated health promotion approach or attend to particular USVI cultural mores. This article describes the systematic development of a theory based, culturally tailored, integrated health promotion intervention that addresses IPV and HIV among USVI women experiencing abuse. The process included: (i) identifying and integrating evidence-based health promotion interventions, (ii) conducting formative research using focus groups, (iii) synthesizing focus group data to inform intervention development and (iv) developing a culturally and linguistically appropriate intervention specific to the needs and concerns of USVI women. The Empowered Sisters Project: Making Choices Reducing Risks (ESP) was developed through this research. ESP is a three-session health promotion curriculum focussed on enhancing sexual health and safety among women experiencing abuse. The ESP intervention components included promoting condom use, increasing IPV and HIV knowledge and developing a personalized safety plan. Health professionals facilitated individual intervention sessions using culturally tailored visual media and scripts. This program focussed on experiences of women living in the USVI and has implications for utility across the Caribbean diaspora. [ABSTRACT FROM AUTHOR]

African-American women have disproportionate rates of hypertension that can be further complicated as they transition through menopause. Stress, coupled with depression and hypertension in perimenopausal African-American women has not been fully explored. This study examines the associations of stress, depression, and social support on systolic blood pressure (SBP) among a sample of 184 perimenopausal African-American women. We used descriptive statistics, Pearson's correlation, and logistic regression to analyze data stratified by menopausal status (perimenopausal or menopausal) and SBP status (<130 mmHg vs. >130 mmHg). Women classified as menopausal reported higher levels of stress and depressive symptoms, and lower levels of social support. Age, body mass index (BMI), health insurance, and perceived health status were significant predictors of SBP in menopausal women. Stress, depression, and social support did not play a role in SBP. It is necessary that future research focus on reducing cardiovascular risk include addressing menopausal health. [ABSTRACT FROM AUTHOR]

This study examined the effects of an educative, self-regulation intervention on blood pressure self-efficacy, self-care outcomes, and blood pressure control in adults receiving hemodialysis. Simple randomization was done at the hemodialysis unit level. One hundred eighteen participants were randomized to usual care (n = 59) or intervention group (n = 59). The intervention group received blood pressure education sessions and 12 weeks of individual counseling on self-regulation of blood pressure, fluid, and salt intake. There was no significant increase in self-efficacy scores within (F = .55, p = .46) or between groups at 12 weeks (F = 2.76, p = .10). Although the intervention was not successful, results from the total sample (N = 118) revealed that self-efficacy was significantly related to a number of self-care outcomes including decreased salt intake, lower interdialytic weight gain, increased adherence to blood pressure medications, and fewer missed hemodialysis appointments. Increased blood pressure self-efficacy was also associated with lower diastolic blood pressure. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the sociocultural factors related to weight behaviors in African American adolescents utilizing a social ecological approach. A descriptive correlational design included a sample of 145 African American adolescents. Perceived familial socialization, ethnic identity, physical activity, and eating behavior patterns were measured. Data were analyzed using descriptive statistics, Pearson product–moment correlations, and multiple regression equations. Perceived maternal socialization was significantly related to adolescent eating behaviors and physical activity whereas perceived paternal socialization was significantly related only to their physical activity. The adolescents’ ethnic identity was not significantly related to their eating behaviors or physical activity. Health care providers who work with adolescents and their families can use the initial findings from this study to encourage healthy weight-related behaviors while reducing the obesity epidemic within the African American adolescent population in a developmentally appropriate and culturally sensitive manner. [ABSTRACT FROM AUTHOR]

Background: Studies examining the effectiveness of treatment in reducing the noises of death rattle have been conducted; however, the physical impact of death rattle on the patient experiencing the phenomenon has not been investigated. Treatments may be undertaken to appease family and staff but these treatments may be more burdensome than beneficial to the patient. Further, nonbeneficial treatments increase the cost of care. Objective: To determine if patients with naturally occurring death rattle experience respiratory distress. Design: A prospective, two-group observation study was conducted. Patients who were near death were stratified into those with and without death rattle. Setting/Subjects: Seventy-one dying patients were recruited from three palliative care and hospice settings. Patients were excluded if they had an artificial airway or if their clinical condition caused a secondary source of death rattle, identified as pseudo-death rattle. Measurements: Daily observations were made for death rattle intensity and respiratory distress along with use of antisecretory medications. Results: About half of the sample had no death rattle (55%).There were no differences in respiratory distress when patients with and without death rattle were compared ( t=1.48, p=0.143). Death rattle intensity and respiratory distress were not correlated ( r=−0.13, p=0.477). Few patients (17%) were medicated with antisecretory agents. Many (58%) patients receiving an antisecretory agent did not experience a reduction in death rattle. Conclusions: Respiratory distress was not associated with death rattle among patients who were near death. In many cases, antisecretory agents did not produce quiet breathing. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To determine the feasibility of a standardized yoga intervention for survivors of non-small cell lung cancer (NSCLC) and, effects on sleep, mood, salivary cortisol levels, and quality of life (QOL).Design: This 14-week, one-group, repeated-measures study included a three-week preintervention phase, eight weeks of yoga classes (40 minutes once per week) and home practice, and a three-week postintervention phase. Follow-up occurred at three and six months poststudy.Setting: A community-based cancer support center in the midwestern United States.Sample: 7 adults who had completed initial treatment for stages I-IIIa NSCLC.Methods: A standardized yoga protocol was developed prior to the study by experts in the field. Breathing ease was monitored before, during, and after classes to assess feasibility of movement without compromising respiratory status while doing yoga. Data analysis included descriptive statistics, repeated-measures analysis of variance, and salivary cortisol analysis.Main Research Variables: Sleep quality, mood, salivary cortisol, and QOL were assessed using the Pittsburgh Sleep Quality Index, Profile of Mood States-Brief, a cortisol measurement, and the Medical Outcomes Survey SF-36®, respectively. Breathing ease was assessed using a dyspnea numeric rating scale as well as observation of participants.Findings: Participants with varying stages of disease and length of survivorship were able to perform yoga without respiratory distress. Class attendance exceeded 95%, and all practiced at home. Mood, sleep efficiency, and QOL significantly improved; salivary cortisol levels decreased over time.Conclusions: Yoga was feasible for NSCLC survivors without further compromising breathing with movement. Potential benefits were identified, supporting the need for future clinical trials with larger samples stratified by cancer stage, treatment, and length of survivorship.Implications for Nursing: Nurses and healthcare providers should consider yoga as a mind-body practice to manage stress, improve mood and sleep, and potentially enhance QOL for NSCLC survivors. [ABSTRACT FROM AUTHOR]

This study examined the severity, pattern, and correlates of fatigue among adults undergoing hemodialysis. Measures included the Piper Fatigue Scale (PFS-12), Patient-Reported Outcomes Measurement Information System (PROMIS) -- Fatigue, Charlson Comorbidity Index, and Six-Minute Walk Test (6MWT). Patients were excluded if mobility or cardiovascular issues prevented conducting the 6MWT. Participants were 86 cognitively intact adults (M = 61.7 years, SD = 13.81), predominantly male (58.1%), and African American (48.8%), with 80% reporting fatigue in the week prior to hemodialysis. Significant increases were noted in sensory and cognitive fatigue from pre- to post-dialysis, while the 6MWT distance decreased significantly pre- to post-dialysis. Factors significantly associated with pre-dialysis fatigue included low hemoglobin, younger age, and living with someone else, while comorbidities and dialysis inadequacy were trending to significant associations with fatigue. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To determine the long-term effects of prostate cancer treatment on spouse quality of life (QOL) at 36 months following treatment.Design: Descriptive-exploratory; community-based study.Setting: Telephone interviews.Sample: 95 female spouses of men treated for early-stage prostate cancer.Methods: A computer-assisted telephone interview was used to evaluate QOL among spouses of prostate cancer survivors at 36 months after initial prostate cancer treatment.Main Research Variables: Lymphedema, demographic information, self-reported comorbid diseases or medical issues, and medication usage.Findings: Spouses who had more negative appraisal of caregiving had lower sexual satisfaction, poorer cancer-specific QOL, and poorer mental QOL. Spouses who perceived bother related to the patient's sexual or hormone function reported more threatening appraisals of caregiving, less sexual satisfaction, and poorer QOL.Conclusions: Spouses continued to experience negative appraisal of caregiving, which affected QOL 36 months after their husbands' treatment for prostate cancer. Additional studies related to factors that influence spouse QOL during survivorship will help guide clinical practice.Implications for Nursing: Healthcare providers must help spouses find strategies that promote positive coping and lessen negative appraisal. Giving caregivers information early in the treatment process will help them understand what to expect over time. Supporting caregivers and helping them manage stress will enhance QOL during survivorship.Knowledge Translation: Spouses who experienced more bother related to urinary, sexual, and hormonal function experience more stress and worse QOL at 36 months post-treatment. Spouse appraisal can have a significant effect on QOL. Offering counseling to couples following treatment for prostate cancer may improve QOL by helping couples manage relationship intimacy. [ABSTRACT FROM AUTHOR]