kimberly shea | University of Arizona (original) (raw)

Papers by kimberly shea

Research paper thumbnail of A Patient-Focused Framework Integrating Self-Management and Informatics

Journal of Nursing Scholarship, Dec 19, 2013

Purpose: This article introduces a framework to (a) guide chronic illness selfmanagement interven... more Purpose: This article introduces a framework to (a) guide chronic illness selfmanagement interventions through the integration of self-management and nursing informatics, (b) focus self-management research, and (c) promote ethical, patient-empowering technology use by practicing nurses. Methods: Existing theory and research focusing on chronic illness, selfmanagement, health-enabling technology, and nursing informatics were reviewed and examined and key concepts were identified. A care paradigm focusing on concordance, rather than compliance, served as the overall guiding principle. Findings: This framework identifies key relationships among selfmanagement (patient behaviors), health force (patient characteristics), and patient-defined goals. The role of health-enabling technology supporting these relationships is explored in the context of nursing informatics. Conclusions: The Empowerment Informatics framework can guide intervention design and evaluation and support practicing nurses' ethical use of technology as part of self-management support. Clinical Relevance: Nurses worldwide provide support to patients who are living with chronic illnesses. As pressures related to cost and access to care increase, technology-enabled self-management interventions will become increasingly common. This patient-focused framework can guide nursing practice using technology that prioritizes patient needs.

Research paper thumbnail of Development and Feasibility of Delivering Clinical Skin Examination Education to Nurse Practitioners Using a Digital, Microlearning Approach (Preprint)

BACKGROUND Skin cancer is the most common cancer; survival of the most serious skin cancer, malig... more BACKGROUND Skin cancer is the most common cancer; survival of the most serious skin cancer, malignant melanoma, depends on early detection. Early detection relies on accessibility to clinical skin examination (CSE). Primary care nurse practitioners (PCNPs) are well-positioned to conduct CSE; however, they require further education on CSE and have time constraints for continuing education. A digital intervention grounded in microlearning is a promising approach to deliver new information over a brief timespan. OBJECTIVE To develop and explore the feasibility of implementing a 1-week online video intervention with content on CSE skills (defined as melanoma risk assessment, head-to-toe skin examination and pigmented lesion assessment) for PCNPs. Specific aims were 1) to develop three theory-based, brief skin cancer videos containing content on CSE and were suitable for online delivery to PNCPs and 2) to determine intervention enrollment, retention and adherence, and acceptability and u...

Research paper thumbnail of Advancing Liver Cancer Prevention for American Indian Populations in Arizona: An Integrative Review

International Journal of Environmental Research and Public Health, 2022

Liver cancer is a highly fatal condition disproportionately impacting American Indian populations... more Liver cancer is a highly fatal condition disproportionately impacting American Indian populations. A thorough understanding of the existing literature is needed to inform region-specific liver cancer prevention efforts for American Indian people. This integrative review explores extant literature relevant to liver cancer in American Indian populations in Arizona and identifies factors of structural inequality affecting these groups. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the methodology, and a literature search was conducted in PubMed, EMBASE, CINAHL, and PsycInfo for articles including Arizona American Indian adults and liver disease outcomes. Seven articles met the inclusion criteria in the final review. Five of the studies used an observational study design with secondary analysis. One article used a quasiexperimental approach, and another employed a community-engagement method resulting in policy change. The results revealed a ...

Research paper thumbnail of The Intersection of Hispanic Culture and Home Telemonitoring

... Telemonitoring in a patient's home becomes a part of daily activities and is a window in... more ... Telemonitoring in a patient's home becomes a part of daily activities and is a window into the privacy of his or her life. ... Secondary Investigators. 550 W. North Street – Indianapolis, IN 46202 USA | 888.634.7575 (TOLL FREE - US/CANADA only) | +1.317.634.8171 (INTNL). ...

Research paper thumbnail of Communication Influences on Health Efforts in Home Telemonitoring

... Further research is needed to explore this vital combination of disease management andtelemon... more ... Further research is needed to explore this vital combination of disease management andtelemonitoring. ... Secondary Investigators. 550 W. North Street – Indianapolis, IN 46202 USA | 888.634.7575 (TOLL FREE - US/CANADA only) | +1.317.634.8171 (INTNL). ...

Research paper thumbnail of Feasibility and Acceptability of a Neonatal Project ECHO (NeoECHO) as a Dissemination and Implementation Strategy to Prevent Necrotizing Enterocolitis

Worldviews on Evidence-Based Nursing, 2021

BACKGROUND Caregivers in the neonatal intensive care unit (NICU) often determine care practices i... more BACKGROUND Caregivers in the neonatal intensive care unit (NICU) often determine care practices in silos, although access to learning communities can improve quality. Project ECHO, a telehealth-delivered mentoring intervention, provides specialists' expertise but not in the NICU until now. Necrotizing enterocolitis (NEC) prevention and timely recognition is one area where specialist support and engaging with a learning community could improve outcomes. NEC-Zero is one care bundle that aims to improve care quality by providing tools to implement NEC prevention in family-engaged ways. AIMS To examine the feasibility and acceptability of NeoECHO to disseminate NEC-Zero education and describe the intentions of internal facilitators (IFs) and clinicians to initiate quality improvement changes. METHODS This was a convergent mixed-methods study. Our team delivered the first neonatal adaptation of Project ECHO called "NeoECHO" to leverage facilitation as an implementation strategy to disseminate NEC-Zero evidence and support practice change. RESULTS Six IFs and seven NICUs participated. All units and IFs that began the series finished it. Of the 261 session attendees, 206 (79%) study evaluations were completed. Of those who completed evaluations, 89 (100%) completed at least one session and 29 (33%) completed three or more. Satisfaction was high. Participants appreciated the engaged and accessible format to learn from experts using real case examples and didactic sessions. Individuals and IFs reported intentions to adopt evidence based on NeoECHO. LINKING EVIDENCE TO ACTION NeoECHO was an acceptable and feasible way to engage under-resourced NICUs and share NEC-Zero evidence and tools. More research is needed to examine the impact of NeoECHO on care processes and patient outcomes.

Research paper thumbnail of The Lived Experience of Persons With Malignant Pleural Mesothelioma in the United States

Cancer Nursing, 2019

BACKGROUND Malignant pleural mesothelioma (MPM) is a rare but deadly cancer. Although there is an... more BACKGROUND Malignant pleural mesothelioma (MPM) is a rare but deadly cancer. Although there is an emerging picture of the individual MPM experience, the United States is underrepresented in this literature. With the United States contributing more deaths from MPM than any other country, findings from this study will enhance a global body of literature on the lived experience of this devastating cancer. OBJECTIVE The aims of this descriptive phenomenological research study were to explore the lived experience of MPM in the United States and identify unmet patient needs. INTERVENTIONS/METHODS This was a descriptive phenomenology study employing semi-structured individual interviews with persons with MPM. RESULTS A total of 7 persons with MPM from a large northeastern US medical center participated. Three major themes about the MPM lived experience emerged: (1) uncertainty/worry about the future, (2) value in relationships, and (3) adapting to a new norm. CONCLUSIONS Findings from this study are consistent with other MPM research, noting a high symptom burden, lifestyle changes, and feelings of uncertainty about the future. However, participants also expressed feelings of hope and optimism. Particularly salient to the MPM experience was the role of communication with the healthcare team as well as other persons with MPM. IMPLICATIONS FOR PRACTICE Timely, coordinated, and personalized care as well as skilled communication should be the cornerstone of care for persons with MPM. Supportive care strategies that address uncertainty, the high symptom burden, feelings of isolation, and existential concerns are also integral to quality care.

Research paper thumbnail of Improving End-of-Life Quality Through the Implementation and Testing of a Ketamine Protocol for Reduction of Depression and Pain (TH308A)

Journal of Pain and Symptom Management, 2018

Research paper thumbnail of Manual demands and consequences of rock climbing

The Journal of Hand Surgery, 1992

Types of rock climbing, hand-grip techniques, and training practices used by rock climbers are de... more Types of rock climbing, hand-grip techniques, and training practices used by rock climbers are described. A survey was completed by 46 climbers. Three fourths of the climbers reported a climbing-related injury; of these injured climbers, almost one half reported a hand or wrist injury. More than half of the injured climbers had been treated by a physician for their injury. More than half of all climbers reported distal interphalangeal or proximal interphalangeal joint pain while climbing. Case reports of three climbers with acute hand injuries are presented to illustrate the minimal effects of their residual deficits on their climbing abilities. A wider understanding of the manual aspects of rock climbing and an awareness of the patterns and incidence of injuries in this sport will facilitate prevention, treatment, and rehabilitation.

Research paper thumbnail of Development of an Intentional Telehealth Viewing Guide for Home-Based Patient Assessment

Telemedicine Reports, 2021

Background: The increased use of telehealth to visit patients in their home permits greater acces... more Background: The increased use of telehealth to visit patients in their home permits greater access to care, and also increases the opportunity for whole-person assessments that improve individualized care. The videoconferencing camera is a proxy for home visit provider's eyes. However, cameras limit views, thereby reducing environmental cues. The Novice to Expert Theory of skill acquisition supports the use of an intentional viewing guide to assure a comprehensive patient assessment using telehealth in the home (CPATH). This study advances the development of a CPATH framework to guide providers to be intentional when using televideo technology. Methods: A quantitative content validity approach was used to determine the validity of a priori items within domains that were in the original protocol framework. A content validity determination requires 5-10 experts to rate agreement (range 1-5) on items within domains. Our sample was composed of seven expert home health providers. More than five experts had to agree to achieve statistical significance (p < 0.05) for validity. Results: Of the 15 items in the protocol, only 8 items had significant agreement for the sample size. These items were breathing, nonverbal gesturing, positioning, oxygen, safety, and types, dosages, and administration guidance of medication. Other items were added within the existing domains of Patient Characteristics, Treatment and Equipment Functioning, Medications and Environmental Quality, with the exception of Caregivers. Conclusion: The domains triggered considerations for existing or additional items that require assessment, thereby developing the intentional guide framework that permits individualization of a telehealth home-based visit.

Research paper thumbnail of Gender Differences in End-of-Life Care in Older Mexican American Adults

Journal of Palliative Care

Mexican Americans (MAs), 1 of 10 subgroups of Latinos, are the largest and fastest growing Latino... more Mexican Americans (MAs), 1 of 10 subgroups of Latinos, are the largest and fastest growing Latino subgroup in the United States; yet, their access to end-of-life (EOL) care using hospice services is low. An investigation was needed into extant research-based knowledge about factors influencing EOL care decisions among MAs to guide health-care professionals in assisting MAs to make timely, acceptable, and satisfactory EOL care decisions. To determine whether gender was an influence on EOL decision-making among older MAs, CINAHL and PubMed were searched for articles published between 1994 and 2018. Relevant sources were also identified through the reference lists of review articles. Reports were included if they were written in English, involved participants aged 50 years and older who identified themselves as MA, and data derived directly from participants. Reports in which MAs were not equally represented in the sample, large databases, and instrumentation development and testing ar...

Research paper thumbnail of Breaking Access and Distance Barriers: Using Innovative Modalities of Tele-Palliative Care (TH364)

Journal of Pain and Symptom Management

Research paper thumbnail of A Model to Evaluate Data Science in Nursing Doctoral Curricula

Nursing Outlook

Building on the efforts of the American Association of Colleges of Nursing, we developed a model ... more Building on the efforts of the American Association of Colleges of Nursing, we developed a model to infuse data science constructs into doctor of philosophy (PhD) curriculum. Using this model, developing nurse scientists can learn data science and be at the forefront of data driven healthcare. Here we present the Data Science Curriculum Organizing Model (DSCOM) to guide comprehensive doctoral education about data science. Our team transformed the terminology and applicability of multidisciplinary data science models into the DSCOM. The DSCOM represents concepts and constructs, and their relationships, which are essential to a comprehensive understanding of data science. Application of the DSCOM identified areas for threading as well as gaps that require content in core coursework. The DSCOM is an effective tool to guide curriculum development and evaluation towards the preparation of nurse scientists with knowledge of data science.

Research paper thumbnail of Perspectives on Policy and the Value of Nursing Science in a Big Data Era

Nursing science quarterly, 2018

As data volume explodes, nurse scientists grapple with ways to adapt to the big data movement wit... more As data volume explodes, nurse scientists grapple with ways to adapt to the big data movement without jeopardizing its epistemic values and theoretical focus that celebrate while acknowledging the authority and unity of its body of knowledge. In this article, the authors describe big data and emphasize ways that nursing science brings value to its study. Collective nursing voices that call for more nursing engagement in the big data era are answered with ways to adapt and integrate theoretical and domain expertise from nursing into data science.

Research paper thumbnail of Symptom Trajectories After an Emergency Department Visit for Potential Acute Coronary Syndrome

Nursing Research, 2016

Many patients evaluated for acute coronary syndrome (ACS) in emergency departments (EDs) continue... more Many patients evaluated for acute coronary syndrome (ACS) in emergency departments (EDs) continue to experience troubling symptoms after discharge-regardless of their ultimate medical diagnosis. However, comprehensive understanding of common post-ED symptom trajectories is lacking. The aim of this study was to identify common trajectories of symptom severity in the 6 months after an ED visit for potential ACS. This was a secondary analysis of data from a larger observational, prospective study conducted in five U.S. EDs. Patients (N = 1005) who had electrocardiogram and biomarker testing ordered, and were identified by the triage nurse as potentially having ACS, were enrolled. Symptom severity was assessed in the hospital after initial stabilization and by telephone at 30 days and 6 months using the validated 13-item ACS Symptom Checklist. Growth mixture modeling was used for the secondary analysis. The eight most commonly reported symptoms (chest discomfort, chest pain, chest pressure, light-headedness, shortness of breath, shoulder pain, unusual fatigue, and upper back pain) were modeled across the three study time points. Models with increasing numbers of classes were compared, and final model selection was based on a combination of interpretability, theoretical justification, and statistical fit indices. The sample was 62.6% male with a mean age of 60.2 years (SD = 14.17 years), and 57.1% ruled out for ACS. Between two and four distinct trajectory classes were identified for each symptom. The seven different types of trajectories identified across the eight symptoms were labeled &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;tapering off,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;mild/persistent,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;moderate/persistent,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;moderate/worsening,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;moderate/improving,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;late onset, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;severe/improving.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; Trajectories differed on age, gender, and diagnosis. Research on the individual nature of symptom trajectories can contribute to patient-centered, rather than disease-centered, care. Further research is needed to verify the existence of multiple symptoms trajectories in diverse populations and to assess the antecedents and consequences of individual symptom trajectories.

Research paper thumbnail of Sociotechnical influences on outcomes in telehomecare

Research paper thumbnail of Social relations modeling in telehomecare

Amia Annual Symposium Proceedings Amia Symposium Amia Symposium, Feb 1, 2007

Telehomecare usage requires that patients, home-helpers and nurses interact as a group using remo... more Telehomecare usage requires that patients, home-helpers and nurses interact as a group using remote communication technology. Group interaction produces many levels of social variance that contribute to outcomes. It is unknown how social variances in remote interaction influence outcomes. Social Relations Model (SRM) approach is currently used to analyze individual, relational and group influences on family outcomes. SRM applied to telehomecare groups contributes to better understanding of the influence of remote relationships on patient outcomes.

Research paper thumbnail of The Veterans Affairs's Corporate Data Warehouse: Uses and Implications for Nursing Research and Practice

Nursing administration quarterly

The Department of Veterans Affairs Veterans Healthcare Administration (VHA) is supported by one o... more The Department of Veterans Affairs Veterans Healthcare Administration (VHA) is supported by one of the largest integrated health care information systems in the United States. The VHA's Corporate Data Warehouse (CDW) was developed in 2006 to accommodate the massive amounts of data being generated from more than 20 years of use and to streamline the process of knowledge discovery to application. This article describes the developments in research associated with the VHA's transition into the world of Big Data analytics through CDW utilization. The majority of studies utilizing the CDW also use at least one other data source. The most commonly occurring topics are pharmacy/medications, systems issues, and weight management/obesity. Despite the potential benefit of data mining techniques to improve patient care and services, the CDW and alternative analytical approaches are underutilized by researchers and clinicians.

Research paper thumbnail of The Veterans Affairsʼs Corporate Data Warehouse

Nursing Administration Quarterly, 2015

The Department of Veterans Affairs Veterans Healthcare Administration (VHA) is supported by one o... more The Department of Veterans Affairs Veterans Healthcare Administration (VHA) is supported by one of the largest integrated health care information systems in the United States. The VHA&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Corporate Data Warehouse (CDW) was developed in 2006 to accommodate the massive amounts of data being generated from more than 20 years of use and to streamline the process of knowledge discovery to application. This article describes the developments in research associated with the VHA&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s transition into the world of Big Data analytics through CDW utilization. The majority of studies utilizing the CDW also use at least one other data source. The most commonly occurring topics are pharmacy/medications, systems issues, and weight management/obesity. Despite the potential benefit of data mining techniques to improve patient care and services, the CDW and alternative analytical approaches are underutilized by researchers and clinicians.

Research paper thumbnail of The role of exploratory practice constraints on performance and depth of knowledge /

Computer printout. Thesis (M.S. - Nursing)--University of Arizona. Includes bibliographical refer... more Computer printout. Thesis (M.S. - Nursing)--University of Arizona. Includes bibliographical references (leaves 109-113).

Research paper thumbnail of A Patient-Focused Framework Integrating Self-Management and Informatics

Journal of Nursing Scholarship, Dec 19, 2013

Purpose: This article introduces a framework to (a) guide chronic illness selfmanagement interven... more Purpose: This article introduces a framework to (a) guide chronic illness selfmanagement interventions through the integration of self-management and nursing informatics, (b) focus self-management research, and (c) promote ethical, patient-empowering technology use by practicing nurses. Methods: Existing theory and research focusing on chronic illness, selfmanagement, health-enabling technology, and nursing informatics were reviewed and examined and key concepts were identified. A care paradigm focusing on concordance, rather than compliance, served as the overall guiding principle. Findings: This framework identifies key relationships among selfmanagement (patient behaviors), health force (patient characteristics), and patient-defined goals. The role of health-enabling technology supporting these relationships is explored in the context of nursing informatics. Conclusions: The Empowerment Informatics framework can guide intervention design and evaluation and support practicing nurses' ethical use of technology as part of self-management support. Clinical Relevance: Nurses worldwide provide support to patients who are living with chronic illnesses. As pressures related to cost and access to care increase, technology-enabled self-management interventions will become increasingly common. This patient-focused framework can guide nursing practice using technology that prioritizes patient needs.

Research paper thumbnail of Development and Feasibility of Delivering Clinical Skin Examination Education to Nurse Practitioners Using a Digital, Microlearning Approach (Preprint)

BACKGROUND Skin cancer is the most common cancer; survival of the most serious skin cancer, malig... more BACKGROUND Skin cancer is the most common cancer; survival of the most serious skin cancer, malignant melanoma, depends on early detection. Early detection relies on accessibility to clinical skin examination (CSE). Primary care nurse practitioners (PCNPs) are well-positioned to conduct CSE; however, they require further education on CSE and have time constraints for continuing education. A digital intervention grounded in microlearning is a promising approach to deliver new information over a brief timespan. OBJECTIVE To develop and explore the feasibility of implementing a 1-week online video intervention with content on CSE skills (defined as melanoma risk assessment, head-to-toe skin examination and pigmented lesion assessment) for PCNPs. Specific aims were 1) to develop three theory-based, brief skin cancer videos containing content on CSE and were suitable for online delivery to PNCPs and 2) to determine intervention enrollment, retention and adherence, and acceptability and u...

Research paper thumbnail of Advancing Liver Cancer Prevention for American Indian Populations in Arizona: An Integrative Review

International Journal of Environmental Research and Public Health, 2022

Liver cancer is a highly fatal condition disproportionately impacting American Indian populations... more Liver cancer is a highly fatal condition disproportionately impacting American Indian populations. A thorough understanding of the existing literature is needed to inform region-specific liver cancer prevention efforts for American Indian people. This integrative review explores extant literature relevant to liver cancer in American Indian populations in Arizona and identifies factors of structural inequality affecting these groups. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the methodology, and a literature search was conducted in PubMed, EMBASE, CINAHL, and PsycInfo for articles including Arizona American Indian adults and liver disease outcomes. Seven articles met the inclusion criteria in the final review. Five of the studies used an observational study design with secondary analysis. One article used a quasiexperimental approach, and another employed a community-engagement method resulting in policy change. The results revealed a ...

Research paper thumbnail of The Intersection of Hispanic Culture and Home Telemonitoring

... Telemonitoring in a patient's home becomes a part of daily activities and is a window in... more ... Telemonitoring in a patient's home becomes a part of daily activities and is a window into the privacy of his or her life. ... Secondary Investigators. 550 W. North Street – Indianapolis, IN 46202 USA | 888.634.7575 (TOLL FREE - US/CANADA only) | +1.317.634.8171 (INTNL). ...

Research paper thumbnail of Communication Influences on Health Efforts in Home Telemonitoring

... Further research is needed to explore this vital combination of disease management andtelemon... more ... Further research is needed to explore this vital combination of disease management andtelemonitoring. ... Secondary Investigators. 550 W. North Street – Indianapolis, IN 46202 USA | 888.634.7575 (TOLL FREE - US/CANADA only) | +1.317.634.8171 (INTNL). ...

Research paper thumbnail of Feasibility and Acceptability of a Neonatal Project ECHO (NeoECHO) as a Dissemination and Implementation Strategy to Prevent Necrotizing Enterocolitis

Worldviews on Evidence-Based Nursing, 2021

BACKGROUND Caregivers in the neonatal intensive care unit (NICU) often determine care practices i... more BACKGROUND Caregivers in the neonatal intensive care unit (NICU) often determine care practices in silos, although access to learning communities can improve quality. Project ECHO, a telehealth-delivered mentoring intervention, provides specialists' expertise but not in the NICU until now. Necrotizing enterocolitis (NEC) prevention and timely recognition is one area where specialist support and engaging with a learning community could improve outcomes. NEC-Zero is one care bundle that aims to improve care quality by providing tools to implement NEC prevention in family-engaged ways. AIMS To examine the feasibility and acceptability of NeoECHO to disseminate NEC-Zero education and describe the intentions of internal facilitators (IFs) and clinicians to initiate quality improvement changes. METHODS This was a convergent mixed-methods study. Our team delivered the first neonatal adaptation of Project ECHO called "NeoECHO" to leverage facilitation as an implementation strategy to disseminate NEC-Zero evidence and support practice change. RESULTS Six IFs and seven NICUs participated. All units and IFs that began the series finished it. Of the 261 session attendees, 206 (79%) study evaluations were completed. Of those who completed evaluations, 89 (100%) completed at least one session and 29 (33%) completed three or more. Satisfaction was high. Participants appreciated the engaged and accessible format to learn from experts using real case examples and didactic sessions. Individuals and IFs reported intentions to adopt evidence based on NeoECHO. LINKING EVIDENCE TO ACTION NeoECHO was an acceptable and feasible way to engage under-resourced NICUs and share NEC-Zero evidence and tools. More research is needed to examine the impact of NeoECHO on care processes and patient outcomes.

Research paper thumbnail of The Lived Experience of Persons With Malignant Pleural Mesothelioma in the United States

Cancer Nursing, 2019

BACKGROUND Malignant pleural mesothelioma (MPM) is a rare but deadly cancer. Although there is an... more BACKGROUND Malignant pleural mesothelioma (MPM) is a rare but deadly cancer. Although there is an emerging picture of the individual MPM experience, the United States is underrepresented in this literature. With the United States contributing more deaths from MPM than any other country, findings from this study will enhance a global body of literature on the lived experience of this devastating cancer. OBJECTIVE The aims of this descriptive phenomenological research study were to explore the lived experience of MPM in the United States and identify unmet patient needs. INTERVENTIONS/METHODS This was a descriptive phenomenology study employing semi-structured individual interviews with persons with MPM. RESULTS A total of 7 persons with MPM from a large northeastern US medical center participated. Three major themes about the MPM lived experience emerged: (1) uncertainty/worry about the future, (2) value in relationships, and (3) adapting to a new norm. CONCLUSIONS Findings from this study are consistent with other MPM research, noting a high symptom burden, lifestyle changes, and feelings of uncertainty about the future. However, participants also expressed feelings of hope and optimism. Particularly salient to the MPM experience was the role of communication with the healthcare team as well as other persons with MPM. IMPLICATIONS FOR PRACTICE Timely, coordinated, and personalized care as well as skilled communication should be the cornerstone of care for persons with MPM. Supportive care strategies that address uncertainty, the high symptom burden, feelings of isolation, and existential concerns are also integral to quality care.

Research paper thumbnail of Improving End-of-Life Quality Through the Implementation and Testing of a Ketamine Protocol for Reduction of Depression and Pain (TH308A)

Journal of Pain and Symptom Management, 2018

Research paper thumbnail of Manual demands and consequences of rock climbing

The Journal of Hand Surgery, 1992

Types of rock climbing, hand-grip techniques, and training practices used by rock climbers are de... more Types of rock climbing, hand-grip techniques, and training practices used by rock climbers are described. A survey was completed by 46 climbers. Three fourths of the climbers reported a climbing-related injury; of these injured climbers, almost one half reported a hand or wrist injury. More than half of the injured climbers had been treated by a physician for their injury. More than half of all climbers reported distal interphalangeal or proximal interphalangeal joint pain while climbing. Case reports of three climbers with acute hand injuries are presented to illustrate the minimal effects of their residual deficits on their climbing abilities. A wider understanding of the manual aspects of rock climbing and an awareness of the patterns and incidence of injuries in this sport will facilitate prevention, treatment, and rehabilitation.

Research paper thumbnail of Development of an Intentional Telehealth Viewing Guide for Home-Based Patient Assessment

Telemedicine Reports, 2021

Background: The increased use of telehealth to visit patients in their home permits greater acces... more Background: The increased use of telehealth to visit patients in their home permits greater access to care, and also increases the opportunity for whole-person assessments that improve individualized care. The videoconferencing camera is a proxy for home visit provider's eyes. However, cameras limit views, thereby reducing environmental cues. The Novice to Expert Theory of skill acquisition supports the use of an intentional viewing guide to assure a comprehensive patient assessment using telehealth in the home (CPATH). This study advances the development of a CPATH framework to guide providers to be intentional when using televideo technology. Methods: A quantitative content validity approach was used to determine the validity of a priori items within domains that were in the original protocol framework. A content validity determination requires 5-10 experts to rate agreement (range 1-5) on items within domains. Our sample was composed of seven expert home health providers. More than five experts had to agree to achieve statistical significance (p < 0.05) for validity. Results: Of the 15 items in the protocol, only 8 items had significant agreement for the sample size. These items were breathing, nonverbal gesturing, positioning, oxygen, safety, and types, dosages, and administration guidance of medication. Other items were added within the existing domains of Patient Characteristics, Treatment and Equipment Functioning, Medications and Environmental Quality, with the exception of Caregivers. Conclusion: The domains triggered considerations for existing or additional items that require assessment, thereby developing the intentional guide framework that permits individualization of a telehealth home-based visit.

Research paper thumbnail of Gender Differences in End-of-Life Care in Older Mexican American Adults

Journal of Palliative Care

Mexican Americans (MAs), 1 of 10 subgroups of Latinos, are the largest and fastest growing Latino... more Mexican Americans (MAs), 1 of 10 subgroups of Latinos, are the largest and fastest growing Latino subgroup in the United States; yet, their access to end-of-life (EOL) care using hospice services is low. An investigation was needed into extant research-based knowledge about factors influencing EOL care decisions among MAs to guide health-care professionals in assisting MAs to make timely, acceptable, and satisfactory EOL care decisions. To determine whether gender was an influence on EOL decision-making among older MAs, CINAHL and PubMed were searched for articles published between 1994 and 2018. Relevant sources were also identified through the reference lists of review articles. Reports were included if they were written in English, involved participants aged 50 years and older who identified themselves as MA, and data derived directly from participants. Reports in which MAs were not equally represented in the sample, large databases, and instrumentation development and testing ar...

Research paper thumbnail of Breaking Access and Distance Barriers: Using Innovative Modalities of Tele-Palliative Care (TH364)

Journal of Pain and Symptom Management

Research paper thumbnail of A Model to Evaluate Data Science in Nursing Doctoral Curricula

Nursing Outlook

Building on the efforts of the American Association of Colleges of Nursing, we developed a model ... more Building on the efforts of the American Association of Colleges of Nursing, we developed a model to infuse data science constructs into doctor of philosophy (PhD) curriculum. Using this model, developing nurse scientists can learn data science and be at the forefront of data driven healthcare. Here we present the Data Science Curriculum Organizing Model (DSCOM) to guide comprehensive doctoral education about data science. Our team transformed the terminology and applicability of multidisciplinary data science models into the DSCOM. The DSCOM represents concepts and constructs, and their relationships, which are essential to a comprehensive understanding of data science. Application of the DSCOM identified areas for threading as well as gaps that require content in core coursework. The DSCOM is an effective tool to guide curriculum development and evaluation towards the preparation of nurse scientists with knowledge of data science.

Research paper thumbnail of Perspectives on Policy and the Value of Nursing Science in a Big Data Era

Nursing science quarterly, 2018

As data volume explodes, nurse scientists grapple with ways to adapt to the big data movement wit... more As data volume explodes, nurse scientists grapple with ways to adapt to the big data movement without jeopardizing its epistemic values and theoretical focus that celebrate while acknowledging the authority and unity of its body of knowledge. In this article, the authors describe big data and emphasize ways that nursing science brings value to its study. Collective nursing voices that call for more nursing engagement in the big data era are answered with ways to adapt and integrate theoretical and domain expertise from nursing into data science.

Research paper thumbnail of Symptom Trajectories After an Emergency Department Visit for Potential Acute Coronary Syndrome

Nursing Research, 2016

Many patients evaluated for acute coronary syndrome (ACS) in emergency departments (EDs) continue... more Many patients evaluated for acute coronary syndrome (ACS) in emergency departments (EDs) continue to experience troubling symptoms after discharge-regardless of their ultimate medical diagnosis. However, comprehensive understanding of common post-ED symptom trajectories is lacking. The aim of this study was to identify common trajectories of symptom severity in the 6 months after an ED visit for potential ACS. This was a secondary analysis of data from a larger observational, prospective study conducted in five U.S. EDs. Patients (N = 1005) who had electrocardiogram and biomarker testing ordered, and were identified by the triage nurse as potentially having ACS, were enrolled. Symptom severity was assessed in the hospital after initial stabilization and by telephone at 30 days and 6 months using the validated 13-item ACS Symptom Checklist. Growth mixture modeling was used for the secondary analysis. The eight most commonly reported symptoms (chest discomfort, chest pain, chest pressure, light-headedness, shortness of breath, shoulder pain, unusual fatigue, and upper back pain) were modeled across the three study time points. Models with increasing numbers of classes were compared, and final model selection was based on a combination of interpretability, theoretical justification, and statistical fit indices. The sample was 62.6% male with a mean age of 60.2 years (SD = 14.17 years), and 57.1% ruled out for ACS. Between two and four distinct trajectory classes were identified for each symptom. The seven different types of trajectories identified across the eight symptoms were labeled &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;tapering off,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;mild/persistent,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;moderate/persistent,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;moderate/worsening,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;moderate/improving,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;late onset, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;severe/improving.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; Trajectories differed on age, gender, and diagnosis. Research on the individual nature of symptom trajectories can contribute to patient-centered, rather than disease-centered, care. Further research is needed to verify the existence of multiple symptoms trajectories in diverse populations and to assess the antecedents and consequences of individual symptom trajectories.

Research paper thumbnail of Sociotechnical influences on outcomes in telehomecare

Research paper thumbnail of Social relations modeling in telehomecare

Amia Annual Symposium Proceedings Amia Symposium Amia Symposium, Feb 1, 2007

Telehomecare usage requires that patients, home-helpers and nurses interact as a group using remo... more Telehomecare usage requires that patients, home-helpers and nurses interact as a group using remote communication technology. Group interaction produces many levels of social variance that contribute to outcomes. It is unknown how social variances in remote interaction influence outcomes. Social Relations Model (SRM) approach is currently used to analyze individual, relational and group influences on family outcomes. SRM applied to telehomecare groups contributes to better understanding of the influence of remote relationships on patient outcomes.

Research paper thumbnail of The Veterans Affairs's Corporate Data Warehouse: Uses and Implications for Nursing Research and Practice

Nursing administration quarterly

The Department of Veterans Affairs Veterans Healthcare Administration (VHA) is supported by one o... more The Department of Veterans Affairs Veterans Healthcare Administration (VHA) is supported by one of the largest integrated health care information systems in the United States. The VHA's Corporate Data Warehouse (CDW) was developed in 2006 to accommodate the massive amounts of data being generated from more than 20 years of use and to streamline the process of knowledge discovery to application. This article describes the developments in research associated with the VHA's transition into the world of Big Data analytics through CDW utilization. The majority of studies utilizing the CDW also use at least one other data source. The most commonly occurring topics are pharmacy/medications, systems issues, and weight management/obesity. Despite the potential benefit of data mining techniques to improve patient care and services, the CDW and alternative analytical approaches are underutilized by researchers and clinicians.

Research paper thumbnail of The Veterans Affairsʼs Corporate Data Warehouse

Nursing Administration Quarterly, 2015

The Department of Veterans Affairs Veterans Healthcare Administration (VHA) is supported by one o... more The Department of Veterans Affairs Veterans Healthcare Administration (VHA) is supported by one of the largest integrated health care information systems in the United States. The VHA&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Corporate Data Warehouse (CDW) was developed in 2006 to accommodate the massive amounts of data being generated from more than 20 years of use and to streamline the process of knowledge discovery to application. This article describes the developments in research associated with the VHA&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s transition into the world of Big Data analytics through CDW utilization. The majority of studies utilizing the CDW also use at least one other data source. The most commonly occurring topics are pharmacy/medications, systems issues, and weight management/obesity. Despite the potential benefit of data mining techniques to improve patient care and services, the CDW and alternative analytical approaches are underutilized by researchers and clinicians.

Research paper thumbnail of The role of exploratory practice constraints on performance and depth of knowledge /

Computer printout. Thesis (M.S. - Nursing)--University of Arizona. Includes bibliographical refer... more Computer printout. Thesis (M.S. - Nursing)--University of Arizona. Includes bibliographical references (leaves 109-113).