04/25/16  Portland, Ore.

OHSU School of Nursing presents their research findings at OHSU Research Week

OHSU Research Week is a PhD student driven event. The planning committee includes representation from across OHSU including Quin Denfeld, Elise Erickson and Virginia Tilden who represent OHSU SON.

Kick Off to Research Week on Monday at 9:30 a.m., hosted by OHSU School of Nursing Graduate Nursing Senate.

Don't forget to catch the panel discussion with Virginia Tilden about Troubleshooting Negative Data and Non-significant findings on Wednesday, May 4, 2016 from 11:30 a.m. –12:30 p.m.

Check out the Research Week website to download an app to track your schedule.

Oral Presentations

(View full schedule)

Oral Presentations –session 1 – Faculty and Students from OHSU School of Nursing

Time: Monday, May 2, 2016 3:00 p.m. - 4:30 p.m.

Location: Old Library 217

Association with baseline cytokine levels and symptom development in head and neck cancer patients

Benjamin Schultze

Introduction: Patients with head and neck cancer (HNC) are particularly vulnerable to developing symptoms associated with cachexia. The association between pre-treatment cytokines and symptoms of cachexia is unknown.
Objective: To examine if pre-treatment levels of cytokines associated with changes over-time in reported symptoms of cachexia. METHODS: This study was a secondary analysis of data from a four-year prospective longitudinal, descriptive study. Data values were collected on 56 patients at the initiation and conclusion of treatment as well as at 6 and 12-months. The Vanderbilt Head and Neck Symptom Survey (VHNSS) was used to measure symptoms. The operationalization of "change" in symptoms was accomplished by subtracting baseline symptoms scores from respective values at 6-months and 12-months post-treatment. A multiple linear regression of baseline cytokines on each of the resulting symptom change values was conducted. RESULTS: Lower TGF-β2 (p=0.002) and higher CRP (p=0.035) prior to treatment associated with increased depression at 12-months. Higher baseline levels of IL-6 (p=0.006), IL-10 (p=0.008) and MMP2a (p=0.035) associated with worsening nutrition consumption at 6-months. Baseline lower levels of TGF-β1 (p=0.014), IFN-y (p=0.048) at 6-months and IL-6 (p=0.041) at 12-months associated with worsening nutrition symptoms. Higher initial levels of IL-6 (p=0.006), IL-10 (p=0.003) were associated with increased difficulty swallowing solids at 12-months. Higher IL-1β associated with increased mucositis symptoms 6-months post-treatment (p=0.035) and pain at 6-months (p=0.031). Higher initial IL-6 associated with worsening xerostomia at 6-months (p=0.042) and IL-10 at 6-months (p=0.021) and 12-months (p=0.024). CONCLUSION: Pre-treatment cytokines may indicate the future development of HNC patient symptoms.

Oral presentations - session 2

Time: Monday, May 2, 2016 3:00 p.m. - 4:30 p.m.

Location: Old Library 211

Overall Care in Adult Intensive Care Units: Family Members' Perspectives

Lissi Hansen, Susan Rosenkranz, Richard Mularski, Michael Leo

Background: In intensive care units, family members' perspectives about the quality of care provided have become an important part of quality improvement.

Objective: To understand family members' of medical patients perspectives of overall care in two adult intensive care units at two U.S. health care institutions.

Methods: Family member responses to three open-ended questions included in the Family Satisfaction with Care in the Intensive Care Unit survey were analyzed using conventional content analysis.

Results: Of 150 responding family members, 106 answered the questions. Of a total of 240 responses, individual family member comments were more frequently complimentary than critical of care provided. Three main themes (competent care, communication, environment) and nine subthemes were identified.

Conclusions: Overall findings were similar to those reported by researchers in other countries. Findings support care delivery to improve communication, address low nurse-patient ratios, support family members, and care for their relative as a person.

Simulation that Enhances Students' Teamwork and Communication: An Integrative Review

Sulaiman Dawood Al Sabei, Kathie Lasater, Amy Ross

Purpose: This integrative review identified the role of interprofessional simulation in enhancing health profession students' teamwork and communication competencies.

Background: Ineffective teamwork and communication are associated with negative patient health outcomes. Research suggests simulation-based interprofessional education engages future health-care providers in collaborative experiences that enhance teamwork and communication. However, literature reviews focus on collaboration with few examining teamwork and communication or core competencies of interprofessional collaboration.

Methods: A literature search was conducted using five electronic databases: MEDLINE, PubMed, CINAHL, Scopus, and Education Resources Information Center. Search terms included interprofessional, education, interdisciplinary, cooperative behavior, collaboration, team, communication, and simulation. Included studies were peer-reviewed quantitative studies published in English after 2003 about interprofessional simulation conducted with pre-licensure students, and teamwork and communication as primary outcomes.

Results: The search yielded a total of 381 articles, 21 met the inclusion criteria. Effects of interprofessional simulation were evaluated related to types of simulation and impact on students learning outcomes. Studies included high to low-fidelity simulation and live actors. Consensus revealed that interprofessional simulation had positive effects on enhancing teamwork and communication. Simulation improved students' knowledge of teamwork functioning, communication skills, and recognition of healthcare professional's roles. Two gaps were identified: limited investigation of the long-term effects of interprofessional simulation on patient outcomes and limited study of the retention of knowledge and skills.

Implications: Future rigorous study designs, such as longitudinal RCTs with pre- and posttests, to explore the long-term effects of simulation on improving student's teamwork and communication will aid in moving interprofessional simulation forward.

Oral presentations - session 12

Time: Wednesday, May 4, 2016 1:30 p.m. - 3:00 p.m.

Location: OHSU Auditorium

Decision-Making Involvement of Hospitalized Persons with Dementia: A Dyadic Study

Lyndsey M. Miller, Christopher S. Lee, Carol J. Whitlatch, Jill A. Bennett, Karen S. Lyons

Purpose of the Study: To examine the everyday decision-making involvement of persons with dementia (PWDs) from the perspectives of hospitalized patients with dementia and their family caregivers, and to identify factors associated with the dyad's perception of greater involvement of patients in decision making

Design and Methods: Using multilevel modeling, we examined cross-sectional data collected from 42 family care dyads in the acute care setting.

Results: Average ratings of the PWD's decision-making involvement (scale 0-3) were 2.11±0.10 and 2.09±.10 for PWDs and family caregivers, respectively, indicating that both members of the dyad rated the PWD on average as being "somewhat involved". There was a significant amount of variability around the average perceptions of PWD involvement in decision-making for both PWDs (χ2 = 351.02, p <.001) and family caregivers (χ2 = 327.01, p <.001). Both PWDs and family caregivers were significantly more likely to perceive greater PWD involvement in decision-making when the family caregiver reported the PWD as valuing autonomy. Additionally, PWDs were significantly more likely to report greater involvement when they had higher MMSE scores. Finally, family caregivers perceived significantly greater involvement of the patient in decision-making when they reported less strain in the relationship. Together, these variables accounted for 38% and 42% of the variability in PWDs' and family caregivers' perceptions, respectively, of the PWD's decision-making involvement.

Implications: Although decision-making abilities decline with advancing dementia, these results indicate that working with families to support PWDs in their value of autonomy may help prolong PWDs' decision-making involvement.

Oral presentations - session 14

Time: Wednesday, May, 4, 2106 1:30 p.m. - 3:00 p.m.

Location: Old Library 221

Ventricular Assist Device Therapy in Patient-Caregiver Dyads: Changes in Quality of Life and Affective Symptoms

Julie T. Bidwell, Karen S. Lyons, James O. Mudd, Jill M. Gelow, Christopher V. Chien, Shirin O. Hiatt, Christopher S. Lee

Background: Person-oriented outcomes such as quality of life (QOL) and affective symptoms (anxiety, depression) in patients and caregivers during ventricular assist device (VAD) therapy are of increasing interest to clinicians and researchers, as well as patients and families. However, little is known quantitatively about how person-oriented outcomes change for patients and their caregivers from pre- to post-implant within the context of the caregiving dyad.

Methods: This was a prospective longitudinal study of VAD patients and their primary informal caregivers ( = 41 dyads). Data on person-oriented outcomes (Depression: Patient Health Questionnaire-8;Anxiety: Brief Symptom Inventory;QOL: Kansas City Cardiomyopathy Questionnaire for patients, Short Form-36 Physical Component Summary for caregivers) were collected prior to implant and 1 and 3 months post-implant, and were analyzed using parallel process modeling.

Results: While patients on average had clinically meaningful improvements in person-oriented outcomes from pre- to post-implant, caregiver outcomes did not change over time, and affective symptoms remained particularly high. There was substantial variability in responses to VAD for both patients and caregivers, and patient and caregiver affective symptoms and QOL were correlated over time.

Conclusions: This is the first quantitative study of VAD patient-caregiver dyads in modern devices that describes change over time from pre- to post-implant. This work supports the need for future work that studies patients and caregivers together within the context of their relationship and examines variability in responses to VAD therapy, both individually and across patient-caregiver dyads.