Recent Research Publications and Funding

A number of theoretical fatigue frameworks have been developed by nurse scientists with the intention of guiding research, practice, and education in fatigue. However, there is a significant gap between theory development and research utilization of fatigue frameworks in clinical and intervention trials. The purpose of this report is to assess an example of an inductive fatigue framework and a deductive symptom management model: The Integrated Fatigue Model (IFM) and the revised University of California, San Francisco, Symptom Management Model (UCSF-SMM), to investigate their potential to guide future nursing research projects on fatigue. The IFM is a fatigue-specific comprehensive framework of 14 biological and psychosocial patterns that influence signs and symptoms of fatigue and trigger six fatigue dimensions. The developers emphasized that patterns could be interrelated and influence the dimensionality of fatigue. The UCSF-SMM is a multidimensional symptom management model embedded within the three nursing domains: person, environment, and health and illness. The model places symptom perceptions, symptom management strategies, and outcomes within these nursing domains to be the key components of a highly complex symptom management process. The IFM is an important development in the understanding and conceptualization of fatigue in cancer and in HIV/AIDS. However, it does not reach the level of integration of the UCSF-SMM in taking fatigue research a significant step forward by integrating symptom impact, symptom management, and symptom outcomes. Both models have significant weaknesses because of their complexity.  

 This study examines ethnic and gender differences in open-ended immediate responses to an online prompt provided by a nationwide sample of 1,559 individuals in the days following the 9/11 terrorist attacks. These responses were used to predict longitudinal outcomes over the following 2 years. Results show that African Americans and women responded with more emotions (e.g., sadness, sympathy) than did Whites and men. African Americans and women also endorsed violent retaliation less often than did their White, male counterparts. Responding with sadness and sympathy and endorsing violent retaliation were, in turn, associated with higher distress and posttraumatic stress (PTS) symptoms over time. Results reveal considerable ethnic and gender differences in immediate responses to traumatic events that have long-term mental health consequences.

 Accurate self-administration of antiretroviral medication therapy for HIV/AIDS is a significant clinical and ethical concern because of its implications for individual morbidity and mortality, the health of the public, and escalating healthcare costs. However, the traditional construction of patient medication adherence is oversimplified, myopic, and ethically problematic. Adherence relies on existing social power structures and western normative assumptions about the proper roles of patients and providers, and principally focuses on patient variables, obscuring the powerful socioeconomic and institutional influences on behaviour. Some professionals advocate for alternate approaches to adherence, but many of the available alternatives remain conceptually underdeveloped. Using HIV/AIDS as an exemplar, this paper presents medication practice as a theoretical reconstruction and explicates its conceptual and ethical evolution. We first propose that one of these alternatives, medication practice, broadens the understanding of individuals' medication-taking behaviour, speaks to the inherent power inequities in the patient-provider interaction, and addresses the ethical shortcomings in the traditional construal. We then integrate medication practice with feminist thought, further validating individuals' situated knowledge, choices, and multiple roles; more fully recognizing the individual as a multidiminsional, autonomous human being; and reducing notions of obedience and deference to authority. Blame is thus extricated from the healthcare relationship, reshaping the traditionally adversarial components of the interaction, and eliminating the view of adherence as a patient problem in need of patient-centred interventions.

 Background The purpose of this study was to examine whether the characteristics of retail food stores where African-American women shopped mediated the association between their income and intake of fruits and vegetables. Food store characteristics included store type (supermarket, specialty store, limited assortment store, independent grocer), store location (suburbs, city of Detroit), and perceptions of the selection/quality and affordability of fresh produce for sale.

Methods The analysis drew upon data from a probability sample of 266 African-American women living in 2001 in eastside Detroit, which had no supermarkets. Structural equation modeling was used to calculate a path model of direct and indirect effects.

Results Women shopping at supermarkets and specialty stores consumed fruit and vegetables more often, on average, than those shopping at independent grocers. More positive perceptions of the selection/quality, but not affordability, of fresh produce at the retail outlet where they shopped was positively associated with intake, independent of store type and location as well as age, per capita income, and years of education. The results suggested an indirect association between income and fruit and vegetable intake; women with higher per capita incomes were more likely to shop at supermarkets than at other grocers, which in turn was associated with intake.

Conclusions Previous studies have shown that few supermarkets are located in the city of Detroit, a symptom of economic divestment over the past several decades. Results of this study suggest this may have negative implications for dietary quality, particularly among lower-income women.