This site is an archive of a closed Robert Wood Johnson Foundation program, provided for educational and historical purposes. Please note that this content is not routinely updated and that contact information and social links may not work.
Recent Research Publications and Funding
-
|
January 13, 2014 6:00AM
Research suggests that family efficacy-defined as a family's beliefs in its capability to manage different situations in order to achieve a desired outcome-is linked to a decreased likelihood of adolescents to engage in risky health behaviors. It is not clear, however, if this is true for immigrant families when they are encountering with increased challenges in their host countries. To provide holistic nursing care to immigrant families, it is important to know the sources of family efficacy particularly for immigrant adolescents when they are developing health behavior. This integrative review examined existing literature to learn about the sources of family efficacy among immigrant adolescents and how different domain of family efficacy is related to risky behaviors. We examined 22 studies on the topics of immigration, adaptation, risky adolescent behavior, and family function. Findings showed that multidimensional sources of family efficacies (specifically those in the relational, pragmatic, and value-laden domains) exert significant positive effects on immigrant adolescents' health behaviors.
-
|
January 8, 2014 6:00AM
OBJECTIVES: This study further expands on the relationship between nurse staffing levels and patient outcomes, in particular, failure to rescue. Many studies are based on single-site hospitals or single-year data, thus limiting the generalizations of the findings. The purpose was to evaluate in a multisite multiyear study the relationship between unit-level nurse staffing and FTR mortality, for ICU and non-ICU patients.
METHODS: Using administrative and actual unit level nurse staffing data, we used AHRQ 2003 Patient Safety Indicator (2003) software and matched those with the patient's discharge month. Fixed effects multilevel logistic analyses were used to take into account the hierarchical structure of the database and patient clustering within units. We controlled for patient demographics, clinical conditions, and CCS categories.
RESULTS: The majority (94%) of cases were discharged from general care units, ICUs reported higher nurse staffing levels based on patient complexity. Expired cases were 3 years older, male, and nonwhite. For general care discharges, the relationship between RN level HPPD approached significance (P = 0.07), suggesting increased odds of higher FTR mortality with higher staffing levels.
CONCLUSIONS: We did not observe any of the expected associations between the nurse staffing variables and FTR for either general care unit or ICU discharges. The comprehensive risk adjustments provided adequate "leveling of the playing field" to evaluate the impact of unit-based nurse staffing levels on FTR mortality. Future studies should evaluate the influence of unit environment and patient risk.
-
Media's role in broadcasting acute stress following the Boston Marathon bombings| January 7, 2014 6:00AM
This article discusses an Internet-based survey following the Boston Marathon bombings in an effort to compare the impact of media vs. direct exposure on acute stress response to collective trauma.
-
|
January 1, 2014 6:00AM
The impact of undergoing genetic testing in a Dominican population is not well understood. The objective of this investigation was to evaluate the psychological well-being and perceived cardiac risk among Dominicans who underwent genetic testing. Participants completed a qualitative interview and the Short Form-36 (SF-36) questionnaire after cardiac genetic testing. There were 31 subjects evaluated (mean age 42 ± 11 years). Participants revealed three common themes: (a) fear of dying prematurely, (b) guilt of possibly passing on a mutation to their children, and (c) fear of having an implantable cardioverter defibrillator (ICD) shock. Physical components of the SF-36 were within normal limits (46.2 ± 6.6) but elevated for mental components (59.9 ± 5.3). The quality of life and specific themes results determined in this investigation warrant further research in the Dominican population.
-
|
December 12, 2013 6:00AM
AIMS AND OBJECTIVES: To describe sleep patterns and inflammatory response postCPB, determine sleep pattern changes and inflammatory response over time and explore relationships between sleep and biomarkers of stress and inflammation.
BACKGROUND: Despite the numerous citations of the role of sleep in restoration and health maintenance, a paucity of research exists about this phenomenon in patients undergoing CPB. Specifically, there is no research that has explored correlations between sleep patterns and systemic inflammatory response in adult cardiac surgery patients.
DESIGN: Exploratory, repeated-measures, correlational study.
METHOD: Subjects were recruited from a Midwestern urban hospital. Of the 25 eligible subjects, 16 males and four females completed the study. Wrist actigraphy was used to measure sleep variables. Salivary cortisol and C-reactive protein (C-RP) levels were measured daily. Data were collected during postoperative nights/days 1 through 4 (T1-T4).
RESULTS: Subjects' sleep onset latency (SOL) median scores (0 minute) were within normal range across time periods, whereas median scores for wake after sleep onset (WASO > 270 minutes), sleep fragmentation index (SFI >51%), total sleep time (<153 minutes) and sleep efficiency index (SEI <36%) fell outside the normal ranges. Changes in the median sleep scores over time, however, were not significant at p > 0·05. Median cortisol levels were within normal range (0·3-0·8 μg/dl) from T1-T4, but the C-RP level peaked at T2 (median = 2370 pg/ml). Strong correlations were found: (1) between SFI-cortisol (rs = 0·82), C-RP (rs = 0·65) - WBC (rs = 0·69); (2) between SEI-C-RP (rs = 0·58); (3) between WASO-WBC (rs = 0·48), WASO and cross-clamp time (rs = 0·50); and (4) between SOL-age (rs = -0·55) at p < 0·05.
CONCLUSIONS: Subjects were severely sleep-deprived with inflammatory response exaggerations warranting further investigations using larger sample sizes.
RELEVANCE TO CLINICAL PRACTICE: This study offers a foundation for developing a conceptual model explaining mechanisms of sleep disturbance and inflammatory response postCPB. This knowledge is crucial for testing sleep-promoting interventions to modulate inflammatory responses essential for preventing complications, and restoring health.
-
|
December 1, 2013 6:00AM
As the primary providers of round-the-clock bedside care, nurses are well positioned to report on hospital quality of care. Researchers have not examined how nurses’ reports of quality correspond with standard process or outcomes measures of quality. We assess the validity of evaluating hospital quality by aggregating hospital nurses’ responses to a single item that asks them to report on quality of care. We found that a 10% increment in the proportion of nurses reporting excellent quality of care was associated with lower odds of mortality and failure to rescue; greater patient satisfaction; and higher composite process of care scores for acute myocardial infarction, pneumonia, and surgical patients. Nurse reported quality of care is a useful indicator of hospital performance.
-
|
December 1, 2013 6:00AM
Aging at home and in one's community poses unique challenges for older adults with multiple chronic conditions and functional difficulties. Addressing the needs of this complex group and creating supportive living environments are essential to improving quality of life and reducing the personal and societal expenditures of this growing segment of the aging population. This article discusses theoretical frameworks for understanding the interplay between intrinsic personal and external environmental factors that impinge on aging in place, and identifies evidence-informed supportive strategies with the potential to address their daily living needs.
-
|
November 11, 2013 6:00AM
AIM: The aim of this study is to describe relationships among self-rated health, stress, sleep quality, loneliness, and self-esteem, in obese young adult women.
BACKGROUND: Obesity has steadily increased among young adults and is a major predictor of self-rated health.
METHODS: A sample of 68 obese (BMI 30 or higher, mean 35), young (18-34 years, mean 22) adult women were recruited from a health center. Survey data were gathered and analyzed using descriptive and bivariate procedures to assess relationships and group differences.
RESULTS: Scores reflected stress, loneliness, poor sleep quality, and poor self-esteem. There were positive correlations among stress, loneliness, and sleep quality and, a high inverse correlation between loneliness and self-esteem. Those who ranked their health as poor differed on stress, loneliness, and self-esteem when compared to those with rankings of good/very good.
CONCLUSIONS: Assessing and addressing stress, loneliness, sleep quality and self-esteem could lead to improved health outcomes in obese young women.
-
|
November 1, 2013 4:00AM
Background: Nursing research, particularly related to physiological development, often depends on the collection of time series data. The state space approach to time series analysis has great potential to answer exploratory questions relevant to physiological development but has not been used extensively in nursing.
Objectives: To introduce the state space approach to time series analysis and demonstrate potential applicability to neonatal monitoring and physiology.
Method: We present a set of univariate state space models; each one describing a process that generates a variable of interest over time. Each model is presented algebraically and a realization of the process is presented graphically from simulated data. This is followed by a discussion of how the model has been or may be used in two nursing projects on neonatal physiological development.
Results: The defining feature of the state space approach is the decomposition of the series into components that are functions of time; specifically, slowly varying level, faster varying periodic, and irregular components. State space models potentially simulate developmental processes where a phenomenon emerges and disappears before stabilizing, where the periodic component may become more regular with time, or where the developmental trajectory of a phenomenon is irregular.
Discussion: The ultimate contribution of this approach to nursing science will require close collaboration and cross-disciplinary education between nurses and statisticians.
-
|
October 28, 2013 4:00AM
BACKGROUND: Preeclampsia contributes significantly to pregnancy-associated morbidity and mortality as well as future risk of cardiovascular disease in mother and offspring, and preeclampsia in offspring. The lack of reliable methods for early detection limits the opportunities for prevention, diagnosis, and timely treatment.
PURPOSE: The purpose of this study was to explore distinct DNA methylation patterns associated with preeclampsia in both maternal cells and fetal-derived tissue that represent potential biomarkers to predict future preeclampsia and inheritance in children.
METHOD: A convenience sample of nulliparous women (N = 55) in the first trimester of pregnancy was recruited for this prospective study. Genome-wide DNA methylation was quantified in first-trimester maternal peripheral white blood cells and placental chorionic tissue from normotensive women and those with preeclampsia (n = 6/group).
RESULTS: Late-onset preeclampsia developed in 12.7% of women. Significant differences in DNA methylation were identified in 207 individual linked cytosine and guanine (CpG) sites in maternal white blood cells collected in the first trimester (132 sites with gain and 75 sites with loss of methylation), which were common to approximately 75% of the differentially methylated CpG sites identified in chorionic tissue of fetal origin.
CONCLUSION: This study is the first to identify maternal epigenetic targets and common targets in fetal-derived tissue that represent putative biomarkers for early detection and heritable risk of preeclampsia. Findings may pave the way for diagnosis of preeclampsia prior to its clinical presentation and acute damaging effects, and the potential for prevention of the detrimental long-term sequelae.