Research Week 2016 - Poster Presentations

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 Virginia Tilden's presentation, 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.

Poster sessions

(View full schedule)

Time: Monday, May 2, 2016

5:30 p.m. - 6:30 p.m.

Location: Biomedical Information Communications Center New library

Breast cancer survivor sarcopenic obesity prevalence and physical function

Daniel J. Mick

Introduction: Breast cancer survivors (BCS) are at risk of developing sarcopenic obesity (SO), and BCS with SO may have heightened risk of physical function declines. But since a normative SO definition has not been established, SO prevalence and its associations with physical function in BCS remains unclear.

Purpose: To describe SO prevalence in BCS using definitions from the literature, and to compare measures of physical function between BCS with and without SO.

Design: Descriptive, cross-sectional.

Sample: Community-dwelling BCS, 60-87 years old (n=174), treated with chemotherapy and/or radiotherapy (time since diagnosis mean=5.9 years).

Methods: Measures: Muscle, fat, and lean mass (kg);body mass index (kg/m2);usual walk speed (m/sec);handgrip strength (kg);timed chair stand (sec);Physical Performance Battery (PPB) Score;and maximal leg and bench press strength (kg). Differences between women with and without SO were determined by non-parametric Mann-Whitney U tests.

Findings: SO prevalence ranged from 0.0% to 43.6% depending on the definition used. Women with SO had significantly (p<0.05) slower walk speed, and lower grip strength, leg and bench press strength compared to women without SO. Significant group differences on specific outcomes varied depending upon the SO definition used to create groups.

Conclusions: SO appears to be related to poorer physical function among older BCS. SO may thus be a potential mechanism by which cancer treatment leads to physical function limitations;however, a normative definition for SO is needed for determining prevalence, and properly designed prospective studies are needed to confirm relationships of SO with physical function.

Determining level, direction, and rate of change of attentional function in women with breast cancer receiving chemotherapy, a pilot study

Ginger Keller

More information to come

Posttraumatic Growth's Influence on Experienced ICU Nurses

Emily E Calabro

The Posttraumatic Growth Inventory (PTGI) is a scale to quantify the experience of existential growth and has been applied to family members who have undergone traumatic life situations. Applying this index to Intensive Care Unit (ICU) nurses who often care for patients at the end-of-life could provide insight into the relationship between existentially prepared nurses and the level of well-being they report.

Although posttraumatic growth (PTG) has typically focused on family and individuals who face a life-limiting illness, the nurse has a unique role in their everyday exposure to death and illness. Nurses experiencing feelings of loss, conflict, and grief, may extend awareness beyond their environment and embody the experience of self-transcendence and posttraumatic growth.

The objective of applying the PTGI to ICU nurses is to measure the correlation of increased levels of PTG to the years of experience an ICU nurse has. ICU nurses who grow from caring for critically ill and dying patients have improved well-being, resilience, confidence, life-appreciation and compassion satisfaction, which may improve the ability to decrease burnout and compassion fatigue. It is postulated that experienced nurses will have increased levels of PTGI compared to nurses with less than 1 year of ICU experience. A comparative study of these ICU nurses could demonstrate the potential for inner personal strength and a richer spiritual life that one gains by becoming a nurse who works with the critically ill and dying population over time.

Moral Injury in Nurse Second Victims - Wounded Healers in the Workforce

Mady Stovall

Purpose: This purpose of this concept analysis is to explore the relationship of moral injury to moral distress and post-traumatic stress disorder (PTSD) in nurse second victims (N2V).

Background: Moral distress in nursing has been attributed to practicing in high-stakes environments and/or exposure to trauma (i.e., witnessing unnatural/unanticipated deaths, significant morbidity, lateral violence), working in multiple oppressive systems, and many others. Further distressing, professionals hold themselves/are held to unattainable perfection standards. All nurses make mistakes. Patients/families are the first victims;the erring nurse is the second victim.

Methods: Meleis necessitates concept "exploration" when terms do not exist in the nursing lexicon. Major dimensions/components of moral injury (guided by Melies' method) were identified with questions and triggers proposed. Through lenses of psychiatry, psychology, and classical literature, moral injury is linked to existing phenomenon in nursing.

Results: Moral injury is (a) a betrayal of what's right;(b) either by someone who holds legitimate authority, or by one's self;(c) in a high-stakes situation. Veterans' PTSD research uses moral injury as a unique component of the wounded warrior.

Given the previously described normative nursing stressors, then becoming N2V, it is not surprising PTSD is near universally described. Is PTSD a moral injury manifestation in N2V as it is in the wounded warrior?

Conclusion: Viewing the N2V as a wounded healer provides a unique lens for investigating moral injury and its role in N2V lived experiences. Research better defining the N2V experiences is imperative for developing moral injury as a concept in nursing.

Bring Continuous back to CRRT!

Wafaa BinAli

Background: Continuous renal replacement therapy (CRRT) is the therapy of choice for the management of AKI. It is gently removes fluid and toxins, and does not cause rapid shift in fluid and electrolytes. CRRT is prescribed to run for 24 to 72hrs continuously. Unfortunately, interruptions in treatment occur resulting in therapy down-time. The purpose of this pilot study was to assess incidences of therapy interruption and impact on therapy "down-time" (time when no therapy is received).

Method: A chart review of 30 randomly selected patients, who received CRRT between February 2013 and March 2014, was conducted. Charts were reviewed and data were extracted on data collection forms. Data on CRRT order-to-connection time, reasons for CRRT disconnection, frequency of disconnections, and duration of down-time, were collected.

Result: 30 records (13 surgical ICU, 17 medical ICU) were reviewed. The average down-time was 258.5 minutes (4 hrs). There were 1-7 incidents of disconnections per ICU stay per patient. Filter clotting counts for 26% of the total causes of interruption. Only 6 of 57 interruption incidents were due to filter change. CRRT was reconnected 0-5 times in a 72hr period with a range of therapy down-time of 0-1035 mins within 72hrs.

Conclusion: Frequent interruption of therapy and prolonged down-time may decrease dialysis time. Filter clotting is commonly reported as a reason for therapy interruption and further investigation is needed to enhance filter life. Down time should be considered when managing AKI with a closer monitoring of the effect of down-time on azotemic control.

Physical Symptoms and Depression Interact in Predicting Quality-of-Life in Heart Failure

Quin E. Denfeld

Introduction: Quality-of-life (QOL) is an important patient-oriented outcome in heart failure (HF). The interaction effect of physical symptoms and depression in predicting QOL in HF, however, is not well understood.

Hypothesis: There is a strong interaction effect between physical symptoms and depression in predicting QOL among adults with moderate to advanced HF.

Methods: This was a secondary analysis of combined data collected during two prospective cohort studies of symptoms among adults with moderate to advanced HF. Physical symptoms were measured with the Heart Failure Somatic Perception Scale subscale (HFSPS), and depression was measured with the Patient Health Questionnaire-9 (PHQ-9). QOL was measured with the visual analog scale (VAS) of the EQ-5D. Generalized linear modeling was used.

Results: The average age of the sample (n=291) was 56.7±13.3 years, and most were male (61.9%). A majority of subjects were classified as New York Heart Association Class III HF (56.4%), and most had non-ischemic etiology (65.2%). Average VAS score on the EQ-5D was 54.27±22.54. Both HFSPS scores (β = -0.58 ± 0.12, p<0.001) and PHQ9 scores (β = -1.77 ± 0.38, p<0.001) were significantly related to VAS scores. There was a significant interaction effect of HFSPS scores and PHQ9 scores in predicting VAS scores (Figure 1;interaction effect: β = 0.02 ± 0.01, p<0.05;model: R2 = 0.28, F(3,265) = 35.18, p<0.001).

Conclusions: Physical symptoms and depression have strong independent and interactive effects in predicting QOL in HF, indicating that both should be considered concurrently when managing QOL among adults with HF.

Relationship between Heart Failure Self-Care and Health related Quality of Life

Maryam M Alharrasi

Purpose: This integrative review evaluated literature on heart failure self- care (HFSC) and its direct relationship to health related quality of life (HRQOL) in persons with heart failure (HF).

Background: HF is the fastest growing cardiovascular disease globally. It considerably decreases HRQOL, primarily through its symptom burden. Active engagement in HFSC can prevent most hospitalizations resulted from these symptoms and thus improves HRQOL. Existing research suggests that better self-care can improve HRQOL in HF patients. However, there are important inconsistencies across studies. Moreover, American Heart Association 2009 scientific statement, has emphasized the need to establish the direct effect of HFSC on clinical outcomes, including survival and QOL.

Methods: Searches were conducted in April 2015, in MEDLINE, CINHAL databases using the following terms, Heart Failure, Self-Care, Quality Of Life and Self-Management. resulting in 118 articles. A total of 22 articles published between 2009 and 2015 were included in this review.

Results: self-care is associated with HRQOL;however no relationship could be concluded by this review. This review found that self-care maintenance behaviors are more than self-care management behaviors among HF patients. Additionally, physical and mental HRQOL may be affected by self-care, yet more evidence is needed to support this claim.

Implications: Given the progressive nature of HF condition, designing longitudinal experimental studies that test self-care interventions would enhance our understanding of HRQOL in HF. Future studies should present data related to specific HFSC behaviors, physical and mental domains of HRQOL in order to statistically compare and correlate between these variables.

The Role of Couple Communication and Physical Intimacy on Sexual Satisfaction and Quality of Life among Fibromyaligia Patients and their Spouses.

Mashael Faisal Dewan

Fibromyalgia (FM) is achronic widespread pain disorder with a lifetime prevalence in women of 7%. FM has been found to negatively impact patient and spouse quality of life and chronic pain has been shown to negatively affect the couple's ability to engage in physical intimacy. The current cross-sectional study was the first known to examine the role of communication problems and avoidance of physical intimacy on psychological quality of life in couples living with fibromyalgia. A mail survey was used to gather data from 170 patients and their spouses. Patients were on average 54 years of age (range 26-75), had been diagnosed on average 12.3 (7.7) years, knew their spouse on average 28.2 (15.3) year, and were predominantly Caucasian (87%). Women with FM reported significantly more communication problems than their husbands (p<.001), with majority of patients and husbands reporting problems communicating about how fibromyalgia affects them sexually. Multilevel modeling was used to predict dyadic psychological quality of life. Controlling for background characteristics, women reported worse psychological quality of life when they experienced higher severity of disease (p<.001), greater levels of communication problems with their spouse (p<.01) and reported greater avoidance of sex (p<.001);husbands reported poorer psychological quality of life when their spouse with fibromyalgia reported greater severity of disease (p <.05) and they reported greater avoidance of sex (p <.05). The discussion will focus on the important roles of dyadic coping and perceived support within couples in the context of fibromyalgia.

Developing a grounded theory: The influence of pets on older adults' health decision-making

Basilia Basin

Older adults managing chronic disease face many health care decisions. Decisions about how to manage their disease are influenced by factors including quality of life, personal values, and family influences. Within family influences, a pet may be as influential as any other family member. Limited research suggests pets influence when to seek medical attention, adherence to medical advice and living accommodations. However, current research lacks in depth descriptions about how or why pets are influential. By understanding how a pet might facilitate or hinder health decisions, specific interventions can be designed to maximize decisions leading to positive health outcomes and minimize decisions leading to negative health outcomes.

This proposed study will use a prospective, constructivist grounded theory methodology to explore and describe how pets influence health decisions of older adults. Participants will be community-dwelling adults aged 65 or older, managing a chronic disease and care for a pet. Participants will be recruited through four family practice clinics. Using semi-structured individual interviews, participants (N=15-30) will be asked to describe past experiences, or conceivable situations, to elucidate how and when a pet influences health decisions. Interview data will be audio recorded and transcribed verbatim. The grounded theory process will guide data collection, analysis, and theory construction. Through analysis an initial substantive grounded theory framework will be generated about pet influence on health decisions of older adults managing a chronic disease. This substantive theory would provide the first human-animal specific theory in the field of human-animal studies.

Life Satisfaction in Children with ADHD: A Mixed-Methods Study Proposal

Patricia Ann Barfield

Children with ADHD experience serious psychosocial impact and risk across multiple life domains, including family, friends, school, community, and the self-system. They are more likely to experience family conflict, peer rejection, academic underachievement, juvenile delinquency, and poor self-concept, compared to unaffected children. Yet, children with ADHD are primarily evaluated and understood through a lens of biophysical symptoms and functional impairment reported by adult proxies. While such proxy accounts are useful, children's mental health is more than the absence of symptoms.

The proposed study addresses this gap by asking, "What might we learn if we view children with ADHD through a lens of well-being and engage them in a way that not only acknowledges them as credible informants but supports their developmental strengths?"

To answer the question, a mixed-methods approach focused on life satisfaction, a positive indicator of well-being will be examined in children with ADHD ages 7-11. Life satisfaction is assessed using the qualitative Draw-and-Tell Conversation (DTC) and the quantitative Multidimensional Students' Life Satisfaction Scale (MSLSS). Data will also include a parent inventory reflecting family demographics (e.g. age, sex, race/ethnicity, rural/urban), household/health literacy levels, and the standard parent report of ADHD-related items. These variables provide the larger context for interpretation of children's life satisfaction. Bronfenbrenner's Bioecological Model of Human Development provides the theoretical frame (Bronfenbrenner &Morris, 2006). The approach to data analysis includes within method, across methods, and within/across methods and contextual variables. The anticipated outcome is an integrated understanding of how children with ADHD evaluate their life satisfaction.

Subjective and Objective Barriers to the Pre-kidney Transplant Medical Evaluation at an Urban Transplant Center in the United States

Mark Brian Lockwood

Background: Despite our knowledge of barriers to the early stages of the transplant process, we have limited insight into the patient's perspective regarding relevant obstacles to the medical evaluation.

Methods: One-hundred consecutive adults were enrolled at a Midwestern transplant center. Demographic, clinical and quality of life data were collected prior to subjects' visit with the transplant surgeon/nephrologist. Subjects completed the Subjective Barrier Questionnaire three-months after the initial medical evaluation appointment.

Results: Outstanding cancer screening tests, dental evaluations and issues related to excess weight were major barriers to completion, as were lapses in communication between patients and providers. Better role-emotional quality of life and greater income were associated with completing pre-kidney transplant evaluation. Being free of dialysis, reporting low comorbid burden and identifying as ethnicity as Caucasian were also associated with completing pre-kidney transplant evaluation.

Conclusions: Successful completion of the pre-kidney transplant evaluation may be enhanced if patients present to the transplant center with their cancer and dental screening completed prior to the initiation of the medical evaluation. The effect of obesity and HRQOL on evaluation completion needs to be better understood. We identified several barriers that may be amenable to intervention through the use of information technologies and/or Patient Navigators.

Patients' Expectations For Bariatric Surgery: A Concept Analysis

Kiki Amanda Fornero

Purpose: Given the potential to improve outcomes from bariatric surgery through presurgical evaluation and teaching, an enhanced understanding of patients' expectations for surgery is necessary for postoperative success. The purpose of this concept analysis is to examine the literature on patients' expectations for bariatric surgery.

Background: More than two thirds of the U.S. population is classified as overweight or obese (USDHHS, 2012). Bariatric surgery is an increasingly common method of facilitating weight reduction. The patient's experience with postsurgical demands and adherence to treatment is an underdeveloped area of study. The concept of expectation may influence the postsurgical course due to its impact on the patient's satisfaction with surgery.

Methods: A literature search was performed using the terms bariatric surgery, gastroenterostomy, obesity, expect, hope, goal, realistic, and unrealistic. Seventeen out of 106 articles met inclusion criteria. Penrod and Hupcey's method (2005) was used to systematically examine the literature surrounding the concept of expectation.

Results: Although the term 'expectation' is consistently and appropriately used within the literature, the concept is not yet well-defined. The search yielded only one conceptual definition, and research which includes the concept examines a variety of aspects related to it. The concept is applicable and useful because expectations play a role in the decision making process and influence adherence to the demanding postsurgical regimen.

Conclusion: Expectation in the context of bariatric surgery is not yet well-defined. Conceptual clarity is needed to guide practice innovations and future research on the evaluation of patients prior to bariatric surgery.