Publications by authors named "Ann Mayo"

46 Publications

Perceived Stress in Older Dementia Caregivers: Mediation by Loneliness and Depression.

Am J Alzheimers Dis Other Demen 2022 Jan-Dec;37:15333175211064756

School of Public Health and Human Longevity Research, 8784University of California, San Diego, La Jolla, CA, USA.

Coupled with aging, chronic stress experienced by dementia caregivers often leads to deteriorating health. Comparing caregivers and non-caregivers, we tested whether depression and loneliness mediate the relationship between caregiver status and a measure of chronic stress, the Perceived Stress Scale. Seventy-six cognitively normal older adults (mean age 72.7) were identified as caregivers or non-caregivers based on the functional independence of a paired family member. Caregivers reported more perceived stress, depression, and loneliness than non-caregivers. Using multiple mediation analyses, we found that loneliness and depression mediated the relationship of caregiver status with perceived stress. The loneliness effect on perceived stress was both direct and via its relationship with depressive symptoms. The findings suggest loneliness as a likely point of intervention to reduce caregiver stress. Initiatives to enable caregivers to maintain or develop social relationships apart from caregiver responsibilities may mitigate stress and its negative impact on mental and physical health.
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http://dx.doi.org/10.1177/15333175211064756DOI Listing
January 2022

A Call to the CMS: Mandate Adequate Professional Nurse Staffing in Nursing Homes.

Am J Nurs 2021 03;121(3):24-27

The authors of this article are: Ann Kolanowski, PhD, RN, FAAN; Tara A. Cortes, PhD, RN, FAAN; Christine Mueller, PhD, RN, FGSA, FAAN; Barbara Bowers, PhD, RN, FAAN; Marie Boltz, PhD, GNP-BC, FAAN; Deb Bakerjian, PhD, APRN, FAAN, FAANP, FGSA; Charlene Harrington, PhD, RN, FAAN; Lori Popejoy, PhD, RN, FAAN; Amy Vogelsmeier, PhD, RN, FAAN; Margaret Wallhagen, PhD, GNP-BC, AGSF, FGSA, FAAN; Donna Fick, PhD, RN, FAAN; Melissa Batchelor, PhD, RN-BC, FNP-BC, FGSA, FAAN; Melodee Harris, PhD, RN, FAAN; Ruth Palan-Lopez, PhD, GNP-BC, FAAN; Mary Dellefield, PhD, RN, FAAN, Ann Mayo, DNS, RN, FAAN; Diana Lynn Woods, PhD, APRN-BC, FGSA, FAAN; Ann Horgas, PhD, RN, FAAN; Pamela Z. Cacchione, PhD, CRNP, GNP, BC, FGSA, FAAN; Diane Carter, MSN, RN, CS, FAAN; Patricia Tabloski, PhD, GNP-BC, FAAN; and Linda Gerdner, PhD, RN, FAAN. For author affiliations, please see http://links.lww.com/AJN/A205. Contact author: Ann Kolanowski, The authors have disclosed no potential conflicts of interest, financial or otherwise.

Editor's note: This article is by 22 nursing gerontology experts who are all advocates of nursing home reform. They are listed at the end of this article.
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http://dx.doi.org/10.1097/01.NAJ.0000737292.96068.18DOI Listing
March 2021

The lived experience of spiritual well-being amongst family caregivers of persons with dementia on palliative care.

Geriatr Nurs 2021 Jan-Feb;42(1):65-71. Epub 2020 Nov 26.

University of San Diego, Hahn School of Nursing and Health Science; San Diego, California, United States.

Family caregivers of persons with dementia are known to experience caregiver burden, anxiety, and social isolation. Spiritual well-being may help ameliorate these characteristics. The meaning of this phenomenon, though, is not known to have been explored previously within this caregiving population. This hermeneutic phenomenological study examined the lived experiences of spiritual well-being in 10 family caregivers. The analysis of semi-structured interviews revealed 5 prominent themes: being connected, strength, presence, hardships, and duty. Phenomenological writing revealed the essence of spiritual well-being in the context of this study. This understanding will help nurses appreciate the importance some family caregivers place on spirituality and recognize when a family caregiver may benefit from a spiritual guidance referral. Further research is recommended to examine associations between spiritual well-being and burden, depression, and social isolation in caregivers of persons with dementia at different stages of receiving palliative care.
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http://dx.doi.org/10.1016/j.gerinurse.2020.11.005DOI Listing
September 2021

Resistance to change: A concept analysis.

Nurs Forum 2020 Nov 23;55(4):631-636. Epub 2020 Jun 23.

Hahn School of Nursing and Health Science, University of San Diego, San Diego, California.

The purpose of this concept analysis is to explore the concept of resistance and provide an operational definition for nurse leaders. While resistance has been deemed a major barrier to the implementation of successful practice change in popular literature, specific evidence as to how it is a barrier within health care organizations is lacking. The Walker and Avant model of concept analysis was used to analyze the concept of resistance. Literature searches utilized the Cumulative Index for Nursing and Allied Health Literature (CINAHL), PsychARTICLES, and Google scholar. Resistance is defined as an individual's behavior in response to perceived or actual threat in an attempt to maintain baseline status. It may be preceded by and amplified through mistrust, fear, and communication barriers, ultimately influencing the implementation, quality, and sustainability of the change. Historically resistance has been viewed with negative conations due to its potential impact on organizational success. However, resistance is a normal response to a threat to baseline status. Nurse leaders prepared with knowledge of resistance, including the antecedents and attributes, can minimize the potential negative consequences of resistance and capitalize on a powerful impact of change adaptation.
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http://dx.doi.org/10.1111/nuf.12479DOI Listing
November 2020

Lay Caregivers' Experiences With Caring for Persons With Dementia: A Phenomenological Study.

J Gerontol Nurs 2020 Aug 3;46(8):17-27. Epub 2020 Jun 3.

Today, biomedical advancements allow older adults, including those with dementia, to live longer, with most living at home with a lay caregiver. Recent research details the stressful role of caregiving to persons with dementia (PWD). The current qualitative phenomenological study describes the lived experience of caregivers caring for PWD, including their experience with palliative care. A community sample of lay caregivers (N = 11) underwent recorded individual interviews. Interviews were analyzed following van Manen's approach to isolate thematic statements. Most caregivers were older (mean age = 71, SD = 9.6; range = 53 to 84 years) and female (n = 10). Study themes included: (a) Uncertainty: The Slippery Slope, (b) The Sense of Loneliness, (c) Complexities of Frustration, and (d) On the Other Side of the Spectrum. Findings show these caregivers are dealing with a dynamic range of feelings about their experiences. Opportunities exist for health care professionals to discuss such feelings and refer caregivers to supportive services, including palliative care. [Journal of Gerontological Nursing, 46(8), 17-27.].
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http://dx.doi.org/10.3928/00989134-20200527-02DOI Listing
August 2020

Reliability and Validity Measurement Issues: Nothing New to Clinical Nurse Specialists; But Liability Issues, Too?

Authors:
Ann M Mayo

Clin Nurse Spec 2019 Sep/Oct;33(5):203-204

Author Affiliation: Professor, University of San Diego Hahn School of Nursing, California.

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http://dx.doi.org/10.1097/NUR.0000000000000474DOI Listing
September 2019

Patient Survival and Length of Stay Associated With Delayed Rapid Response System Activation.

Crit Care Nurs Q 2019 Jul/Sep;42(3):235-245

Beyster Institute for Nursing Research, University of San Diego Hahn School of Nursing and Health Science, California (Drs Padilla and Mayo); and Department of Nursing Education, Development, and Research, University of California San Diego Health System, California (Dr Padilla).

The objective of this study was to investigate the difference in mortality and length of stay between patients who experienced a delay in rapid response system (RRS) activation and those who did not. A retrospective comparative cohort study investigated all adult inpatient cases that experienced an RRS activation from January 1, 2017, through January 1, 2018. Cases experiencing a delay in RRS activation were compared with cases without delay. During the study period a total of 3580 RRS activations that took place and 1086 RRS activations met inclusion criteria for analysis. Delayed RRS activations occurred in 325 cases (29.8%) and nondelayed RRS activations occurred in 766 cases (70.2%). The mean age was roughly the same for both groups (60 years old) and both groups consisted of approximately 60% males. Delay in activation was significantly associated with an increase in length of hospitalization (19.9 days vs 32.4 days; P < .001) and also a higher likelihood of not surviving hospitalization (hazard ratio = 2.70; 95% confidence interval, 1.96-3.71; P < .001). This study demonstrates that delayed RRS activation occurs frequently and exposes patients to higher mortality and longer length of hospitalization.
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http://dx.doi.org/10.1097/CNQ.0000000000000264DOI Listing
November 2019

Description of work processes used by clinical nurse specialists to improve patient outcomes.

Nurs Outlook 2019 Sep - Oct;67(5):511-522. Epub 2019 Mar 20.

University of San Diego Hahn School of Nursing, San Diego, CA.

Background: Advanced practice registered nurses (APRN) are expected to contribute to improved patient outcomes. Traditionally, clinical nurse specialists (CNS) have been the APRN role that led system-level nursing practice initiatives to advance care for specialty populations. Little is known about the work processes used by CNSs to achieve outcomes.

Purpose: This study identified common processes used by CNSs working in a variety of practice settings and specialties to advance nursing practice and achieve improved clinical outcomes.

Methods: Qualitative descriptive methods were used; a purposeful sample of CNSs with completed system-level projects participated in focus groups. Data were analyzed using standard content analysis process.

Findings: CNSs engaged in intricate interactions identified as articulation work involving the management of intersections between people, technology and organizations. This expert work is largely invisible. Self-agency, trust, and influence are a nexus upon which CNS work processes revolve.

Discussion: The findings provide insight into CNS work processes, lend credibility to the CNS's leadership abilities, and help explain why the CNS role and practice is often considered invisible and ambiguous.
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http://dx.doi.org/10.1016/j.outlook.2019.03.001DOI Listing
October 2019

Adjusting to the transition into assisted living: Opportunities for nurse practitioners.

J Am Assoc Nurse Pract 2019 Oct;31(10):583-590

Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California.

Background And Purpose: Transition from an independent living residence to assisted living (AL) is challenging. The study purpose was to understand such a transition from the perspective of older women.

Methods: A hermeneutic phenomenological approach was used to explore how 17 older women living in a Continuing Care Retirement Community, many of whom were recently widowed, experienced this transition.

Conclusions: Three major themes emerged from the interviews: preplanning, executing, and adjusting to the transition. Even with facility, family and staff assistance, the transition was challenging, and adjustment was affected when participants had physical or sensory impairments.

Implications For Practice: Older adult women transitioning to AL settings should be assessed for adjustment to the new setting. Those with sensory, cognitive, emotional, or physical problems will need additional supportive strategies to help with adjustment. With a rapidly expanding population, AL settings offer new opportunities for nurse practitioners to promote the health and well-being of older adults.
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http://dx.doi.org/10.1097/JXX.0000000000000184DOI Listing
October 2019

Associations among Braak stage, Parkinsonian gait, cognition, and functional status in autopsy-confirmed dementia with Lewy bodies.

Int J Geriatr Psychiatry 2019 05 15;34(5):738-744. Epub 2019 Mar 15.

Shiley-Marcos Alzheimer's Disease Research Center, University of California San Diego, San Diego, CA.

Objective: Compromised functional abilities in older adults with dementia with Lewy bodies (DLB) represent a significant burden to families and frequently lead to institutionalization. Contributing factors to this compromise are poorly understood.

Methods: Using data collected at a first study visit, multiple regression modeling was used to examine the associations between Braak staged Alzheimer disease (AD) pathology, Apolipoprotein E (ApoE) status, Parkinsonian gait, cognition, and functional status from a cohort of 102 cases with an autopsy-confirmed diagnosis of dementia stemming from combined Lewy body and AD pathology.

Results: On average, 60% of functional activities were compromised per case. Worse functional status was associated with older age at first study visit, compromised cognitive status, and Parkinsonian gait after controlling for gender, mental status, and other covariates. Worse cognitive status predicted worse functional status in both the low and high Braak groups.

Conclusions: Older persons with DLB presenting with moderately compromised cognition and Parkinsonian gait should be expected to have impaired functional abilities. Providing these patients with supportive environments may help them to remain independent for longer periods of time.
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http://dx.doi.org/10.1002/gps.5080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461356PMC
May 2019

Instruments for detection and screening of cognitive impairment for older adults in primary care settings: A review.

Geriatr Nurs 2018 May - Jun;39(3):323-329. Epub 2017 Dec 18.

Hahn School of Nursing, University of San Diego, 5998 Alcalá Park, San Diego, CA, 92110 USA.

The Patient Protection and Affordable Care Act requires evaluation for cognitive impairment as part of the Annual Wellness Visit (AWV). Nurses and nurse practitioners in primary care are in a good position to incorporate brief cognitive screens into the AWV. Early recognition of cognitive problems allows clinicians and patients the opportunity to discuss any new or ongoing concerns about cognition, address possible reversible causes, or refer for further evaluation. It should be noted that some patients may prefer not to explore for cognitive impairment. Numerous brief cognitive screens have been developed for primary care, with no one screen being appropriate for all patients or clinicians. This review examines the psychometric properties, usefulness, and limitations of both patient and informant brief (under five minutes) cognitive screens endorsed by the Alzheimer's, National Institute of Aging (NIA), and Gerontological Society (GSA) workgroups, plus a recently developed brief version of the standard MoCA.
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http://dx.doi.org/10.1016/j.gerinurse.2017.11.001DOI Listing
October 2018

Clinical deterioration: A concept analysis.

J Clin Nurs 2018 Apr 15;27(7-8):1360-1368. Epub 2018 Feb 15.

Hahn School of Nursing & Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, CA, USA.

Aims And Objectives: To present a concept analysis of clinical deterioration and introduce an operational definition.

Background: Hospitalised patients who endure cardiopulmonary arrest and unplanned intensive care unit admissions often exhibit physiological signs preceding these events. Clinical deterioration not promptly recognised can result in increased patient morbidity and mortality. A barrier to recognising and responding to clinical deterioration stems from practice variations among healthcare clinicians.

Design: Concept analysis.

Methods: Eight-step method of concept analysis proposed by Walker and Avant.

Results: Defining attributes include dynamic state, decompensation and objective and subjective determination. Antecedents identified include clinical state, susceptibility, pathogenesis and adverse event. Increased mortality, resuscitation, implementation of higher level of care and prolonged hospital admission were the consequences identified. Defining attributes, antecedents and consequences identified led to an operational definition of clinical deterioration as a dynamic state experienced by a patient compromising hemodynamic stability, marked by physiological decompensation accompanied by subjective or objective findings.

Conclusions: Clinical deterioration is a key contributor to inpatient mortality, and its recognition is often underpinned by contextual factors and practice variances. Variation in the uniformity of the concept of clinical deterioration causes a gap in knowledge and necessitated clarification of this phenomenon for nursing research and practice.

Relevance To Clinical Practice: Identifying and intervening on clinical deterioration plays a vital role in the inpatient setting demonstrated by the dynamic nature of a patients' condition during hospitalisation. It is anticipated that this concept analysis on clinical deterioration will contribute to further identification of clinically modifiable risk factors and accompanying interventions to prevent clinical deterioration in the inpatient setting.
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http://dx.doi.org/10.1111/jocn.14238DOI Listing
April 2018

Time to Define the DNP Capstone Project.

Authors:
Ann M Mayo

Clin Nurse Spec 2017 Mar/Apr;31(2):63-65

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http://dx.doi.org/10.1097/NUR.0000000000000287DOI Listing
September 2017

The Advanced Practice Clinical Nurse Specialist.

Nurs Adm Q 2017 Jan/Mar;41(1):70-76

Beyster Institute of Nursing Research, Advanced Practice, and Simulation, Hahn School of Nursing & Health Science, University of San Diego, San Diego, California (Drs Mayo and Urden); National Association of Clinical Nurse Specialists, Philadelphia, Pennsylvania (Ms Ray); Children's Health, Dallas, Texas (Dr Chamblee); and Franciscan Alliance, Hammond, Indiana (Ms Moody).

The clinical nurse specialist (CNS), one of the 4 advanced practice registered nurse (APRN) categories, has a unique role to play in contributing to high-quality patient care and system-level change across multiple health care settings. CNS practice requires advanced knowledge and skills, including specialty expertise, the ability to integrate new knowledge and innovation into the system of care, the ability to consult and collaborate with all health professions, and the mentoring of nursing staff to support and fully implement that new knowledge. The purpose of this article was to describe the role of the CNS, explain the background of the CNS role as it relates to APRN practice, provide current CNS workforce statistics, and share opportunities for hospitals and health systems to strategically use CNSs to advance patient and organizational goals.
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http://dx.doi.org/10.1097/NAQ.0000000000000201DOI Listing
March 2017

Decision Making Among Older Adults at the End of Life: A Theoretical Perspective.

ANS Adv Nurs Sci 2016 Oct/Dec;39(4):308-319

School of Nursing, University of California, San Francisco (Drs Romo, Dawson-Rose, and Wallhagen); and Hahn School of Nursing and Health Sciences and Beyster Institute for Nursing Research, University of San Diego, San Diego, California (Dr Mayo).

Understanding changes in decision making among older adults across time is important for health care providers. We examined how older adults with a limited prognosis used their perception of prognosis and health in their decision-making processes and related these findings to prospect theory. The theme of decision making in the context of ambiguity emerged, reflecting how participants used both prognosis and health to value choices, a behavior not fully captured by prospect theory. We propose an extension of the theory that can be used to better visualize decision making at this unique time of life among older adults.
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http://dx.doi.org/10.1097/ANS.0000000000000139DOI Listing
February 2018

Integrating Geropsychiatric Nursing and Interprofessional Collaborative Practice Competencies Into Adult-Gerontology Clinical Nurse Specialist Education.

Clin Nurse Spec 2016 Nov/Dec;30(6):324-331

Author Affiliations: Professor, Hahn School of Nursing & Health Science, University of San Diego, California (Dr Mayo); Clinical Assistant Professor, College of Nursing, University of Arkansas for Medical Sciences, Little Rock (Dr Harris); and Assistant Professor, College of Nursing, University of Arkansas for Medical Sciences, Fayetteville (Dr Buron).

Specific changes to the national clinical nurse specialist (CNS) certification are necessitating a move away the psychiatric/mental health (P/MH) CNS population focus. However, a rapidly increasing older adult population with P/MH comorbidities such as depression and anxiety means that the adult-gerontology CNS (AGCNS) will likely be coordinating much of the complex care needs of this vulnerable population. Therefore, strategies are needed to ensure AGCNSs are competent in advanced practice P/MH nursing. In addition, at this critical time in the redesign of healthcare, the Institute of Medicine has made interprofessional practice center stage for healthcare professional education. Therefore, the purpose of this manuscript is to propose aligning the current AGCNS population-focused competencies with the CNS geropsychiatric nursing competency enhancements and interprofessional collaborative practice education competencies. Examples of the proposed alignment and educational application strategies are presented. When AGCNS educational curricula encompass P/MH nursing at an advanced level from an interprofessional perspective, future AGCNSs will continue to be positioned to make significant contributions to the design of care systems and monitor and trend important outcomes, while ensuring safe and efficient, high-quality healthcare for older adults with P/MH comorbidities.
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http://dx.doi.org/10.1097/NUR.0000000000000248DOI Listing
May 2017

Clinical Nurse Specialist Roles in Conducting Research: Changes Over 3 Years.

Clin Nurse Spec 2016 Sep-Oct;30(5):292-301

Author Affiliations: Associate Chief Nursing Officer (Dr Albert), Office of Nursing Research and Innovation, Nursing Institute, Cleveland Clinic Health System, Ohio; Director (Dr Rice), The Center for Nursing Research, Ochsner Health System, New Orleans, Louisiana; Regional Director Professional Practice (Dr Waldo), Quality & Research, Providence Health & Services, Oregon Region; Biostatistician (Mr Bena), Statistical Programmer (Ms Morrison), Quantitative Health Sciences, Cleveland Clinic, Ohio; Professor (Dr Mayo), Hahn School of Nursing & Health Science and the Beyster Institute for Nursing Research, University of San Diego, California; Professor (Dr Westlake), School of Nursing, Azusa Pacific University, Monrovia, California; Pulmonary Clinical Nurse Specialist, Director (Dr Ellstrom), Pulmonary Rehabilitation Program, Pulmonary & Critical Care Medicine, VA Loma Linda Healthcare System, California; Professional Nurse Researcher (Dr Powers), Parkview Health System, Fort Wayne, Indiana; and President (Dr Foster), Nursing Inquiry & Intervention, Inc, Woodlands, Texas.

Purpose: The aim of this study is to describe clinical nurse specialists' characteristics, interest, confidence, motivators, and barriers in conducting research.

Design: This study was a descriptive, multicohort design.

Methods: Clinical nurse specialists were recruited electronically through national and local organizations to complete anonymous surveys 3 times, over 3 years. Comparative analyses included χ and Kruskal-Wallis tests.

Results: Of 2052 responders (initial, n = 629; 18 months, n = 465; and 3 years, n = 958), mean (SD) participant age was 50.3 (9.3) years. Overall, 41.7% of participants were involved as principal or coinvestigators in research. Interest in conducting nursing research (on a 0-100 scale) was 61.1 (38.4) and was lowest among the 18-month time point participant group (score, 39.1 [32.2]) and highest at the 3-year time point (68.3, [30.7]; P < .001). Confidence in conducting research, discussion of statistics, and perceptions of motivators and barriers to conducting research did not differ across time period groups. Access to literature and mentors and research knowledge were the most prevalent barriers to conducting research.

Conclusions: Less than 42% of clinical nurse specialists conducted research and the rate did not change between different time groups. Access and knowledge barriers to conducting research were prominent. Workplace leaders need to consider resources and support of academic educational opportunities to increase research conduct by clinical nurse specialists.
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http://dx.doi.org/10.1097/NUR.0000000000000236DOI Listing
May 2017

Phenotypic differences based on staging of Alzheimer's neuropathology in autopsy-confirmed dementia with Lewy bodies.

Parkinsonism Relat Disord 2016 10 21;31:72-78. Epub 2016 Jul 21.

Hahn School of Nursing and Health Science, University of San Diego, United States.

Introduction: The goal was to compare subgroups of dementia with Lewy Bodies (DLB) using neuropathological measures to differentiate 'pure' Lewy body (LB) dementia from 'mixed' DLB [co-occurring LB and Alzheimer's disease (AD) pathology] to facilitate diagnostic decision-making and future development of interventions based on predicted type(s) of neuropathology. Studies comparing these groups are rare relative to those differentiating 'pure' AD and all-cause DLB, and are limited by insufficient sample size, brief cognitive batteries, and/or absence of autopsy confirmation. To address these limitations, we assessed cognition and other features in a large, autopsy-confirmed DLB sample using an extensive neuropsychological battery.

Methods: Subjects from an AD research center autopsy series satisfying DLB pathology criteria were divided by an AD neuropathology index into DLB-LB (Braak stage 0-3) (n = 38) and DLB-AD (Braak stage 4-6) (n = 41) and compared on baseline variables from chart reviews and standardized measures.

Results: DLB-LB subjects were more impaired on visuospatial constructions, visual conceptual reasoning, and speed of processing, but less impaired on verbal memory and confrontation naming. All-type hallucinations occurred more frequently in DLB-LB, while delusions were common in both groups. Groups were similar in education and age at onset, and in baseline age, dementia severity, and functional capacity.

Conclusion: Salient findings included greater impairment on visual tasks and speed of processing and more frequent reports of all-type hallucinations in DLB-LB compared to DLB-AD. Relatively intact confrontation naming in DLB-LB and no differences in reported delusions were of note. Identifying differences in phenotypic features can improve prediction of underlying neuropathology.
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http://dx.doi.org/10.1016/j.parkreldis.2016.07.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5794000PMC
October 2016

Core Practice Outcomes for Clinical Nurse Specialists: A Revalidation Study.

J Prof Nurs 2016 Jul-Aug;32(4):271-82. Epub 2015 Dec 1.

Professor, Hahn School of Nursing and Beyster Institute for Nursing Research, University of San Diego, San Diego, CA.. Electronic address:

Measuring outcomes of clinical nurse specialist (CNS) practice is essential for demonstrating accountability. Literature is limited with respect to the scope of reported CNS outcomes. The National Association of Clinical Nurse Specialists' (NACNS) published listing of CNS outcomes could serve as an outcome measurement framework. Revalidation of these outcomes is an important step in creating a structured outcome measurement approach. The purpose of this descriptive study was to assess CNSs' perceptions of the ongoing validity of NACNS published outcomes. A Web-based survey asked participants to describe, for each of 42 outcomes, the frequency of outcome accountability, importance to practice, and frequency of monitoring. Of the 427 surveys returned, 347 (81%) were included in analysis. Findings demonstrated concordance between identified outcomes and actual CNS practice. When job descriptions included the CNS outcomes, more CNSs reported using the outcomes in practice. Both accountability and importance predicted the monitoring of outcomes (p < .001). This study demonstrated the ongoing validity of NACNS outcomes. Nurse educators must ensure that CNS program curricula are based on the NACNS framework and that successful achievement of program outcomes are congruent with the framework. These outcomes have potential for use as a conceptual framework for guiding future CNS outcome investigations and ongoing monitoring systems. Finally, the findings of this study give voice to CNS practice and provide knowledge about expectations for practice outcomes.
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http://dx.doi.org/10.1016/j.profnurs.2015.11.004DOI Listing
June 2017

Critique of the STOP-Bang Sleep Apnea Questionnaire.

Clin Nurse Spec 2016 Jan-Feb;30(1):11-4

Author Affiliations: Doctoral candidate (Mr Nations) and Professor (Dr Mayo), Hahn School of Nursing & Health Science and Beyster Institute for Nursing Research, University of San Diego, California.

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http://dx.doi.org/10.1097/NUR.0000000000000175DOI Listing
October 2016

A Critique of the Short Test of Functional Health Literacy in Adults.

Clin Nurse Spec 2015 Nov-Dec;29(6):308-12

Author Affiliations: Clinical Nurse Specialist, Sharp Memorial Hospital, San Diego and Adjunct Faculty, Hahn School of Nursing and Health Sciences and Beyster Institute for Nursing Research, University of San Diego (Dr Thomason); and Professor (Dr Mayo), Hahn School of Nursing and Health Science and Beyster Institute for Nursing Research, University of San Diego, California.

Effective healthcare relies on the ability to communicate with patients. Ninety-eight million Americans are estimated to have limited health literacy that can impair their ability to read and interpret health-related education and information. Low health literacy is associated with higher mortality and 30-day hospital readmissions. Clinical nurse specialists and other advanced practice nurses must be able to evaluate and select a health literacy assessment instrument that is both reliable and produces valid data for the populations they serve. To assist with this important decision-making process, the psychometric properties of the Short Test of Functional Health Literacy in Adults are critiqued in the following article.
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http://dx.doi.org/10.1097/NUR.0000000000000156DOI Listing
September 2016

Psychometric Properties of the Multidimensional Scale of Perceived Social Support.

Clin Nurse Spec 2015 Sep-Oct;29(5):258-61

Author Affiliations: Associate Professor, California State University Long Beach, Nursing Department (Dr Hardan-Khalil); and Professor (Dr Mayo), Hahn School of Nursing and Health Science, University of San Diego, California.

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http://dx.doi.org/10.1097/NUR.0000000000000148DOI Listing
October 2016

A review of the Child and Adolescent Social Support Scale for Healthy Behaviors.

Clin Nurse Spec 2015 Jul-Aug;29(4):198-202

Author Affiliations: Faculty (Dr Cullum), School of Nursing, San Diego State University; Professor (Dr Mayo), Hahn School of Nursing and Health Science, University of San Diego, California.

Assessing an instrument's psychometric properties to determine appropriateness for use can be a challenging process. Dissecting the statistical terminology may be even more perplexing. There are several instruments that evaluate adolescents' perceived social support, but a fairly new instrument related to this construct assesses not only the availability of social support but also support for healthy behaviors in this population. The Child and Adolescent Social Support Scale for Healthy Behaviors, first published in 2013, demonstrates adequate initial reliability and validity. The purpose of this article is to review the psychometric properties of the Child and Adolescent Social Support Scale for Healthy Behaviors and potential uses of the instrument.
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http://dx.doi.org/10.1097/NUR.0000000000000142DOI Listing
September 2016

Psychometric instrumentation: reliability and validity of instruments used for clinical practice, evidence-based practice projects and research studies.

Authors:
Ann M Mayo

Clin Nurse Spec 2015 May-Jun;29(3):134-8

Author Affiliation: Post Doctoral Fellow, Hahn School of Nursing & Health Science, University of San Diego, California.

It is important for CNSs and other APNs to consider the reliability and validity of instruments chosen for clinical practice, evidence-based practice projects, or research studies. Psychometric testing uses specific research methods to evaluate the amount of error associated with any particular instrument. Reliability estimates explain more about how well the instrument is designed, whereas validity estimates explain more about scores that are produced by the instrument. An instrument may be architecturally sound overall (reliable), but the same instrument may not be valid. For example, if a specific group does not understand certain well-constructed items, then the instrument does not produce valid scores when used with that group. Many instrument developers may conduct reliability testing only once, yet continue validity testing in different populations over many years. All CNSs should be advocating for the use of reliable instruments that produce valid results. Clinical nurse specialists may find themselves in situations where reliability and validity estimates for some instruments that are being utilized are unknown. In such cases, CNSs should engage key stakeholders to sponsor nursing researchers to pursue this most important work.
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http://dx.doi.org/10.1097/NUR.0000000000000131DOI Listing
October 2016

Transforming care through leadership and research alignment.

Nurs Manage 2013 Dec;44(12):12-5

Bridgett B. Sellars is an assistant professor at the California State University, Fullerton, School of Nursing, in Fullerton, Calif. Ann Mayo is a professor at the University of San Diego School of Nursing in San Diego, Calif.

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http://dx.doi.org/10.1097/01.NUMA.0000437776.45842.51DOI Listing
December 2013

Profile.

Authors:
Ann M Mayo

Clin Nurse Spec 2013 Jul-Aug;27(4):211-2

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http://dx.doi.org/10.1097/NUR.0b013e3182990860DOI Listing
August 2013

Trends and opportunities in geropsychiatric nursing: enhancing practice through specialization and interprofessional education.

J Nurs Educ 2013 Jun 9;52(6):317-21. Epub 2013 May 9.

Harding University-Carr College of Nursing, Searcy, AR 72149, USA.

Forecasted changes in the demographics of the United States suggest there will be an unprecedented need for health care professionals with specific training in geropsychiatric care. An aging society, the dearth of geropsychiatric health care professionals, the shortage of educators, and the lack of interprofessional geropsychiatric education require new strategies for nursing education to address these issues. The vision of the Institute of Medicine serves as a foundation for transforming geropsychiatric nursing and interprofessional education to prepare the next generation of nurses and the geropsychiatric workforce to improve the mental health care of older adults. This article aims to describe the importance and implications of implementing the recently released Geropsychiatric Nursing Competency Enhancements and the Core Competencies for Interprofessional Collaborative Practice to improve the mental health care of older Americans. A secondary aim is to discuss how to overcome barriers in implementing interprofessional education in geropsychiatric nursing care.
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http://dx.doi.org/10.3928/01484834-20130509-03DOI Listing
June 2013

Rapid response teams: qualitative analysis of their effectiveness.

Am J Crit Care 2013 May;22(3):198-210

School of Nursing, University of California Los Angeles, Los Angeles, CA 90095-6917, USA.

Background: Multidisciplinary rapid response teams focus on patients' emergent needs and manage critical situations to prevent avoidable deaths. Although research has focused primarily on outcomes, studies of the actual team effectiveness within the teams from multiple perspectives have been limited.

Objective: To describe effectiveness of rapid response teams in a large teaching hospital in California that had been using such teams for 5 years.

Methods: The grounded-theory method was used to discover if substantive theory might emerge from interview and/or observational data. Purposeful sampling was used to conduct in-person semistructured interviews with 17 key informants. Convenience sampling was used for the 9 observed events that involved a rapid response team. Analysis involved use of a concept or indicator model to generate empirical results from the data. Data were coded, compared, and contrasted, and, when appropriate, relationships between concepts were formed. Results Dimensions of effective team performance included the concepts of organizational culture, team structure, expertise, communication, and teamwork.

Conclusions: Professionals involved reported that rapid response teams functioned well in managing patients at risk or in crisis; however, unique challenges were identified. Teams were loosely coupled because of the inconsistency of team members from day to day. Team members had little opportunity to develop relationships or team skills. The need for team training may be greater than that among teams that work together regularly under less time pressure to perform. Communication between team members and managing a crisis were critical aspects of an effective response team.
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http://dx.doi.org/10.4037/ajcc2013990DOI Listing
May 2013

Improving patient safety to reduce preventable deaths: the case of a California safety net hospital.

J Healthc Qual 2012 Mar-Apr;34(2):64-76

UCLA School of Nursing/UCLA HealthSystem Patient Safety Institute, Los Angeles, CA, USA.

Preventable deaths occur when signs and symptoms of risk and decline are not detected yet are present many hours prior to a deteriorating course. Rapid responses teams (RRTs), also referred to as medical emergency teams (METs) were introduced to improve patient safety by preventing code arrests and death. This research using a case study methodology describes a nurse-led RRT, developed at a large, safety net, teaching hospital in California. Safety-net hospitals are challenged to deliver care and meet the complex needs of vulnerable patient populations. This hospital is a mission driven organization that is focused on the patient and the needs of underserved populations. To respond to the call for reform for patient safety and reduce adverse events, the organization adopted RRTs, early recognition rounds by RRT registered nurses (RNs) and the use of trigger alerts by nursing assistants (NAs) to expand the surveillance and identification of patients most at risk of clinical deterioration. Collaboration with interns and residents (house staff) facilitated their involvement and response to RRT calls. Using quality data from 2005 to 2010, findings from this patient safety innovation address RRT utilization, frequency of non-ICU code arrests, hospital mortality, and post-arrest survival outcomes.
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http://dx.doi.org/10.1111/j.1945-1474.2011.00185.xDOI Listing
January 2014

The relationship between functional status and judgment/problem solving among individuals with dementia.

Int J Geriatr Psychiatry 2013 May 12;28(5):514-21. Epub 2012 Jul 12.

Hahn School of Nursing & Health Science, University of San Diego, San Diego, CA, USA.

Objective: To determine the relationship between functional status (independent activities of daily living) and judgment/problem solving and the extent to which select demographic characteristics such as dementia subtype and cognitive measures may moderate that relationship in older adult individuals with dementia.

Methods: The National Alzheimer's Coordinating Center Universal Data Set was accessed for a study sample of 3,855 individuals diagnosed with dementia. Primary variables included functional status, judgment/problem solving, and cognition.

Results: Functional status was related to judgment/problem solving (r = 0.66; p < 0.0005). Functional status and cognition jointly predicted 56% of the variance in judgment/problem solving (R(2) = 0.56, p < 0.0005). As cognition decreases, the prediction of poorer judgment/problem solving by functional status became stronger.

Conclusions: Among individuals with a diagnosis of dementia, declining functional status as well as declining cognition should raise concerns about judgment/problem solving.
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http://dx.doi.org/10.1002/gps.3854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496819PMC
May 2013
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