Publications by authors named "Anne F Fish"

25 Publications

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The "seeing place": Teaching nurse practitioners about cultural difference through dramatization.

Nurse Educ Today 2021 Feb 28;97:104689. Epub 2020 Nov 28.

College of Nursing, University of Missouri-St. Louis, St. Louis, MO, USA.

Background: The use of dramatization in health professional education is one method to teach students about implicit bias and cultural difference, yet it has not been widely studied among graduate students of nursing.

Objectives: The purpose of this article is to present a qualitative analysis of data regarding doctoral nursing students' responses to a new dramatic exercise as part of a funded project to facilitate cultural learning in a diversity-enhanced nursing curriculum.

Design: We employed a cross-sectional posttest design with qualitative data collection and hermeneutic analysis. Setting and.

Participants: Subjects were students from two cohorts in a Doctor of Nursing Practice program at a large metropolitan university in the Midwestern United States (n = 136).

Methods: Following a dramatic exercise facilitated by a local theatre group, students debriefed and provided feedback via paper-based surveys collected by their instructor. The research team reviewed and analyzed student feedback with an eye toward new learning or insights around cultural difference.

Results: Students rated the dramatic exercise highly. Their written feedback provided for a deeper exploration of how they internalized messages about cultural difference. These experiences were thematized in the following way: (a) Awareness is facilitated through integrating nonverbal (kinesthetic) and verbal encounters, (b) Hesitancy to participate in unfamiliar activities creates tension, and (c) Safety is a foundational aspect of learning sensitive issues.

Conclusion: Dramatization of culturally sensitive scenarios for advanced practice nurses can lead to new understanding. Educators who understand the need for thoughtful introduction of dramatization experiences can better prepare nurses for interaction in cross-cultural clinical environments.
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http://dx.doi.org/10.1016/j.nedt.2020.104689DOI Listing
February 2021

The Role of Extracellular Vesicles in β-Cell Function and Viability: A Scoping Review.

Front Endocrinol (Lausanne) 2020 11;11:375. Epub 2020 Jun 11.

Sensory Science & Metabolism Unit, Biobehavioral Branch, National Institute of Nursing Research, Division of Intramural Research, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, United States.

Extracellular vesicles (EVs) released by cells throughout the body have been implicated in diabetes pathogenesis. Understanding the role of EVs in regulation of β-cell function and viability may provide insights into diabetes etiology and may lead to the development of more effective screening and diagnostic tools to detect diabetes earlier and prevent disease progression. This review was conducted to determine what is known from the literature about the effect of EV crosstalk on pancreatic β-cell function and viability in the pathogenesis of diabetes mellitus, to perform a gap analysis for future research directions, and to discuss implications of available evidence for diabetes care. The literature search yielded 380 studies from which 31 studies were determined to meet eligibility criteria. The majority of studies had the disease context of autoimmunity in T1DM. The most commonly studied EV crosstalk dynamics involved localized EV-mediated communication between β-cells and other islet cells, or between β-cells and immune cells. Other organs and tissues secreting EVs that affect β-cells include skeletal muscle, hepatocytes, adipocytes, immune cells, bone marrow, vascular endothelium, and mesenchymal stem cells. Characterization of EV cargo molecules with regulatory effects in β-cells was conducted in 24 studies, with primary focus on microRNA cargo. Gaps identified included scarcity of evidence for the effect on β-cell function and viability of EVs from major metabolic organs/tissues such as muscle, liver, and adipose depots. Future research should address these gaps as well as characterize a broader range of EV cargo molecules and their activity in β-cells.
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http://dx.doi.org/10.3389/fendo.2020.00375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300279PMC
June 2020

Implementation science: Changing practice in oral health.

Nurse Pract 2020 Jul;45(7):27-34

Carol Berger is an assistant professor of nursing at Maryville University and a hospitalist with Schumacher Group and TeamHealth, St. Louis, Mo. Umit Tokac is an assistant professor at the University of Missouri-St Louis, St. Louis, Mo. Anne F. Fish is an associate professor at the University of Missouri-St. Louis, St. Louis, Mo. John N. Dane is the State Dental Director at the Missouri Department of Health and Senior Services.

Caries remain the most common preventable chronic childhood disease. One state oral health program including fluoride varnish showed a decrease in presence of decay and improvement in overall oral health; however, early childhood caries did not improve. Implementation of an oral health preventive program during well-child medical visits may address this gap.
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http://dx.doi.org/10.1097/01.NPR.0000669132.47036.2cDOI Listing
July 2020

Correction to: Sex differences in 10-year ischemic cardiovascular disease risk prediction in Chinese patients with prediabetes and type 2 diabetes.

BMC Cardiovasc Disord 2020 Apr 16;20(1):177. Epub 2020 Apr 16.

Department of Health Education, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, #100 Hongshan Road, Qi xia District, Nanjing, 210028, Jiangsu Province, China.

After the publication of the original article [1], we were notified that one of the corresponding author's name and her related institution were wrongly spelled.
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http://dx.doi.org/10.1186/s12872-020-01470-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160959PMC
April 2020

Testing a model of body image in the bariatric surgery patient.

Appl Nurs Res 2020 04 7;52:151228. Epub 2020 Jan 7.

Washington University School of Medicine, 4921 Parkview Place, Suite C, Floor 8, St. Louis, MO 63110, United States of America. Electronic address:

Purpose: The purpose was to test a published model of body image in the bariatric surgery patient in the clinical office setting.

Background: A model was created based on clinical observations during field work and the literature. It focuses on five concepts of body image: body attitude, body checking, appearance orientation, perceived body size, and perceived body space. Testing this model 3 months after surgery is important because morphology changes rapidly influencing early changes in body image, yet there is a paucity of research at this time point.

Methods: For this study of 67 bariatric surgery patients, sequential sampling was used. Body image and anthropometric measures (body mass index and other weight loss indicators) were obtained at baseline and 3-months postoperatively. Established model testing criteria were used.

Results: Over 3 months, mean body mass index was significantly reduced. Mean body image was significantly improved regarding all concepts in the model, except body checking. Body image improvement varied widely when individual responses were examined.

Conclusions: The model was successfully tested. Data on the five concepts in the model provided a body image profile at 3 months indicating individuals' degree of improvement. Areas of non-improvement in the early postoperative phase may signal the need for interventions, like support or psychological counseling, for patients who might be struggling with views of themselves after surgery. Preliminary recommendations are made regarding several of the instruments and their use clinically. Researchers should take into consideration the study's short 3-month time frame when designing future studies.
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http://dx.doi.org/10.1016/j.apnr.2019.151228DOI Listing
April 2020

Sex differences in 10-year ischemic cardiovascular disease risk prediction in Chinese patients with prediabetes and type 2 diabetes.

BMC Cardiovasc Disord 2019 12 18;19(1):301. Epub 2019 Dec 18.

Department of Health Education, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, #100 Hongshan Road, Qi xia District, Nanjing, Jiangsu Province, 210028, China.

Background: Cardiovascular disease has become a serious public health problem in recent years in China. The aim of the study was to examine sex differences in cardiovascular risk factors and 10-year ischemic cardiovascular disease (ICVD) risk in Chinese patients with prediabetes (PreDM) and type 2 diabetes mellitus (T2DM).

Methods: This was a multi-site retrospective case-control study conducted from April-November 2016 using an electronic medical record database, involving 217 PreDM and 900 T2DM patients admitted to endocrinology units in four hospitals in China. CVD risk was estimated using the Chinese 10-year ICVD risk model. The differences in 10-year absolute ICVD risk according to PreDM, T2DM < 1 year, T2DM 1-5 years or T2DM ≥5 years and sex were analyzed using ANOVA.

Results: When compared to PreDM females, males with PreDM had significantly higher 10-year ICVD risk In contrast, the opposite pattern of 10-year ICVD risk was observed in T2DM; males had significantly lower 10-year ICVD risk. Moreover, compared to T2DM females, males with T2DM had a lower proportion s with moderate or greater ICVD risk (p < 0.001). When compared to PreDM males, males with T2DM < 1 year, and with T2DM 1-5 years had no difference in 10-year ICVD risk, but had higher ICVD risk with T2DM ≥5 years (p < 0.05). Compared to PreDM females, females with T2DM in all subgroups had higher ICVD risk (p < 0.05). Among those with T2DM, hypertension rates of awareness, treatment and control were 78.60%, 65.38% and 31.10%, respectively; hyperlipidemia rates of awareness, treatment and control were lower (29.15%, 8.30% and 3.47%, respectively). Females with T2DM had higher prevalence, awareness and treatment of hypertension and hyperlipidemia than males with T2DM (p < 0.001).

Conclusions: There is a greater need for cardiovascular risk reduction programs for females with T2DM at diagnosis. Given the low numbers for awareness, treatment and control of hypertension and hyperlipidemia in both males and females, significant resources focused on them must be expended, specifically improving regular assessment of blood pressure and blood lipids. Strengthening the management of chronic diseases through adherence to evidence-based guidelines to enhance clinical treatment may reduce 10-year ICVD in patients with T2DM in China.
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http://dx.doi.org/10.1186/s12872-019-1232-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6933920PMC
December 2019

Identifying the Complexity of Diagnosing Bipolar Disorder: A Focused Ethnography.

Issues Ment Health Nurs 2019 Sep 27;40(9):812-818. Epub 2019 Jun 27.

Centerpointe Hospital , St. Louis , MO , USA.

To identify and describe the complexity of diagnosing bipolar disorder, including the diagnostic process and patient experiences of being newly diagnosed with bipolar disorder. A mixed-methods focused ethnography was conducted, grounded in a post-positivist foundation. Medical records ( = 100) of patients whose diagnosis had been switched to bipolar disorder were examined. Six weeks post-hospitalization, ten outpatients with the diagnosis of bipolar disorder underwent an in-depth interview. Four diagnostic processes were identified during the retrospective record review. Two patterns and five themes were identified from the interviews. The first pattern, living with undiagnosed bipolar disorder, demonstrated common experiences of distinguishing impulsive moods and behavior, suffering life challenges, and seeking relief. The second pattern, acclimating to a new diagnosis of bipolar disorder, demonstrated participants' ways of understanding the diagnosis and reconciling the diagnosis. Patterns in the interviews corroborated data from the record review. The rendering of an appropriate diagnosis is key. Many participants' lives were significantly improved when diagnosis was made, and treatment recommendations for bipolar disorder (BPD) were initiated. These findings offer clinicians and researchers new ways to think about the complexity of the diagnosis of BPD including contrasting decision-making outcomes along a screening, diagnosis, and treatment continuum, as well as using the diagnostic event to instigate meaningful life change in the patient.
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http://dx.doi.org/10.1080/01612840.2019.1615584DOI Listing
September 2019

The Compelling and Persistent Problem of Bipolar Disorder Disguised as Major Depression Disorder: An Integrative Review [Formula: see text].

J Am Psychiatr Nurses Assoc 2018 Sep/Oct;24(5):415-425. Epub 2018 Jun 28.

4 Azfar M. Malik, MD, MBA, Centerpointe Hospital, St. Louis, MO, USA.

Background: Up to 40% of patients with bipolar disorder are misdiagnosed, usually with major depression disorder.

Objective: The purpose was to describe the current state of the science of the misdiagnosis of bipolar disorder, with the ultimate goal of improving psychiatric diagnostic workups including screening.

Design: An integrative review was conducted using standard criteria for evaluating research articles.

Results: Forty-nine articles met the eligibility criteria. Articles explored patient-related and health care provider-related factors contributing to the misdiagnosis of bipolar disorder as well as consequences of misdiagnosis. Clinically oriented, reliable, and valid screening tools for bipolar disorder also were reviewed.

Conclusions: Awareness of multiple, challenging patient-related factors and more comprehensive assessment and screening by health care providers may reduce misdiagnosis.
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http://dx.doi.org/10.1177/1078390318784360DOI Listing
October 2019

A Journey with Amyotrophic Lateral Sclerosis.

J Christ Nurs 2018 Jul/Sep;35(3):152-159

Deborah Jeffery, DNP, RN, is Director of Advanced Illness Management, Palliative Services at the Visiting Nurse Association of Greater St. Louis. She also is Director of Nursing at the Convent of the Immaculate Heart retirement community in St. Louis, Missouri. Anne F. Fish, PhD, RN, is an associate professor at the College of Nursing at the University of Missouri in St. Louis, Missouri.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. Motor neurons are affected in certain patterns, such as cervical, thoracic, lumbar, and bulbar (facial) regions. Although initial presentations can vary, eventually upper and lower motor neurons are lost in the two types of ALS: familial and sporadic. A case study highlighting the reality of living with bulbar ALS relays Sister A's journey from early to late ALS. Etiology, pathophysiology, diagnosis, treatment, and clinical care are discussed.
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http://dx.doi.org/10.1097/CNJ.0000000000000502DOI Listing
September 2019

Conceptualization of body image in the bariatric surgery patient.

Appl Nurs Res 2018 06 26;41:52-58. Epub 2018 Mar 26.

Washington University School of Medicine, 4921 Parkview Place, Suite C, Floor 8, St. Louis, MO 63110, United States. Electronic address:

Bariatric (weight loss) surgery is more popular than ever. The American Society for Metabolic and Bariatric Surgery in 2016 reported that 216,000 bariatric procedures were performed in the United States. Bariatric surgery has major physiological benefits; its use is expected to increase globally. However, patients may not anticipate the profound impact that rapid and massive weight loss may have on their body image after bariatric surgery. The construct of body image in this population needs to be explicated to facilitate continued research regarding this increasingly prevalent healthcare procedure. This article describes the formulation of a model of relevant concepts and dimensions within the construct of body image in the bariatric surgery patient. In the process of creating the model, we identified many factors influencing body image in patients before and after bariatric surgery, summarized eight measures, and developed a new definition based on prior work. Theoretical considerations are discussed. The long-term objective of this model building approach is to encourage researchers and clinicians to test the feasibility of systematic clinical measurement of body image at office visits before as well as multiple times after bariatric surgery.
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http://dx.doi.org/10.1016/j.apnr.2018.03.008DOI Listing
June 2018

Use of the Hage framework for theory construction: Factors affecting glucose control in the college-aged student with type 1 diabetes.

Appl Nurs Res 2017 10 8;37:61-66. Epub 2017 Aug 8.

Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Chinese Medicine, China.

This article describes the Hage framework for theory construction and its application to the clinical problem of glycemic control in college-aged students with type 1 diabetes. College-aged students with type 1 diabetes struggle to self-manage their condition. Glycated hemoglobin (HbA1c), if controlled within acceptable limits (6-8%), is associated with the prevention or delay of serious diabetic complications such as kidney and cardiovascular disease. Diabetes educators provide knowledge and skills, but young adults must self-manage their condition on a daily basis, independent of parents. The Hage framework includes five tasks of theory construction: narrowing and naming the concepts, specifying the definitions, creating the theoretical statements, specifying the linkages, and ordering components in preparation for model building. During the process, concepts within the theory were revised as the literature was reviewed, and measures and hypotheses, foundational to research, were generated. We were successful in applying the framework and creating a model of factors affecting glycemic control, emphasizing that physical activity, thought of as a normal part of wellness, can be a two-edged sword producing positive effect but also serious negative effects in some college-aged students with type 1 diabetes. Contextual factors important to self-management in college-aged students are emphasized. The Hage framework, already used to a small extent in nursing curricula, deserves more attention and, because of its generic nature, may be used as a template for theory construction to examine a wide variety of nursing topics.
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http://dx.doi.org/10.1016/j.apnr.2017.08.001DOI Listing
October 2017

Correlates of pericardial adipose tissue volume using multidetector CT scanning in cardiac patients in China.

Int J Cardiol 2017 Oct 30;244:285-289. Epub 2017 Jun 30.

Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100 Shizi Street Hongshan Rd, Nanjing, Jiangsu Province, China. Electronic address:

Background: Pericardial adipose tissue (PAT) is an emerging cardiovascular risk factor, yet much less is understood about PAT volume in Chinese adults, especially in relation to physical activity. The study explores associations between demographic and clinical variables and PAT volume, using multidetector computed tomography (MDCT) scanning in China. We also examined the relationship between PAT volume and coronary artery disease (CAD).

Methods: An observational, correlational study design was used. Chinese (n=163) attended a study visit and underwent MDCT scanning between September 2014 and December 2015.

Results: Participants were 48.5% male and had a mean age of 60.6 (SD 9.4) years. PAT volume was higher (p=0.001) in males than in females. PAT volume was correlated with age (r=0.388, p=0.001), systolic blood pressure (r=0.205, p=0.009), body mass index (r=0.466, p=0.001), high-density cholesterol (r=-0.282, p=0.001), low-density cholesterol (r=0.177, p=0.024), and triglycerides (r=0.248, p=0.001). Both moderate intensity physical activity energy consumption (r=-0.363, p=0.001) and total physical activity (r=-0.290, p=0.001) had inverse relationships with PAT volume. Total sedentary energy consumption was positively related to PAT volume (r=0.266, p=0.001). Multiple regression revealed that age, male gender, BMI, LDL-C and total physical activity energy consumption were significant predictors of PAT volume (R=0.465). The relationship between PAT volume and CAD was found to be significant in the adjusted models.

Conclusions: Age, male gender, BMI, LDL-C and total physical activity energy consumption were significant predictors of PAT volume, and PAT volume itself is a predictor of CAD.
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http://dx.doi.org/10.1016/j.ijcard.2017.06.114DOI Listing
October 2017

Diabetes-related distress and its associated factors among patients with type 2 diabetes mellitus in China.

Psychiatry Res 2017 06 24;252:45-50. Epub 2017 Feb 24.

Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China; Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China. Electronic address:

Diabetes-related distress is one of the psychological disorders affecting patients with diabetes, yet there are few studies about diabetes-related distress in Chinese patients. To assess the level of psychological distress and examine its associated factors, we conducted a cross-sectional analysis of patients with type 2 diabetes mellitus from a Chinese tertiary hospital. The Diabetes Distress Scale (DDS) and the General Self-Efficacy Scale (GSES) were administered. There were 210 (57.85%) patients with little or no diabetes-related distress, 84 (23.14%) with moderate diabetes-related distress and 69 (19.01%) with high diabetes-related distress. Stepwise multiple linear regression showed that sleep time was significantly related to the DDS total score and the subscale scores of emotional burden (EB) (β=-0.190, -0.379), respectively. GSES was associated with the DDS total score (β=-0.128) and the EB score (β=-0.153). Oral medication plus insulin was significantly related to regimen-related distress (RD) (β=0.137), physician-related distress (PD) (β=0.152) and interpersonal distress (ID) (β=0.103). Physical activity (β=-0.185) and making meal plan with health care professionals(HCP) (β=-0.169) were associated with RD. The prevalence of diabetes-related distress among patients with type 2 diabetes mellitus was high in China. DDS and EB were associated with poorer sleep time and lower self-efficacy. Interventions to improve sleep are needed. Qualitative and longitudinal studies are required to understand why type 2 diabetic patients are not getting enough sleep.
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http://dx.doi.org/10.1016/j.psychres.2017.02.049DOI Listing
June 2017

Knowledge of A1c Predicts Diabetes Self-Management and A1c Level among Chinese Patients with Type 2 Diabetes.

PLoS One 2016 9;11(3):e0150753. Epub 2016 Mar 9.

Department of Medical Education & Senior Research Scientist, Michigan Diabetes Research & Training Center, Ann Arbor, United States of America.

This study was to identify current A1c understanding status among Chinese patients with type 2 diabetes, assess if knowledge of A1c affects their diabetes self-management and their glycemic control and recognize the factors influencing knowledge of A1c among patients with type 2 diabetes. A multi-center, cross-sectional survey was conducted between April and July 2010 in 50 medical centers in the Mainland China. Participants were recruited from inpatients and outpatients who were admitted to or visited those medical centers. The survey included core questions about their demographic characteristics, diabetes self-management behavior, and A1c knowledge. Overall, of 5957 patients, the percentage of patients with good understanding was 25.3%. In the multivariable logistic regression model, the variables related to the knowledge of A1c status are presented. We discovered that patients with longer diabetes duration (OR = 1.05; 95%CI = 1.04-1.06) and having received diabetes education (OR = 1.80; 95%CI = 1.49-2.17) were overrepresented in the good understanding of A1c group. In addition, compared to no education level, higher education level was statistically associated with good understanding of A1c (P<0.001). The percentage of patients with good understanding varied from region to region (P<0.001), with Eastern being highest (OR = 1.54; 95%CI = 1.32-1.80), followed by Central (OR = 1.25; 95%CI = 1.02-1.53), when referring to Western. Only a minority of patients with type 2 diabetes in China understood their A1c value. The patients who had a good understanding of their A1c demonstrated significantly better diabetes self-management behavior and had lower A1c levels than those who did not.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150753PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784822PMC
July 2016

Psychosocial factors not metabolic control impact the quality of life among patients with type 2 diabetes in China.

Acta Diabetol 2016 Aug 11;53(4):535-41. Epub 2016 Jan 11.

Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China.

Aims: Quality of life is a major focus of health care today. In published studies on patients with type 2 diabetes, findings on quality of life are mixed. Those with diabetes have chronic illness and must adhere to a complicated care regimen daily, which for many patients is challenging. This study analyzed psychosocial factors and metabolic control as potential predictors of quality of life among these patients.

Methods: A cross-sectional study of 397 patients with type 2 diabetes was conducted in a hospital in Nanjing, China. Demographic information and clinical characteristics were collected from the medical record. The World Health Organization Quality of Life-BREF, General Self-Efficacy Scale, Diabetes Distress Scale, and Diabetes Empowerment Scale-Short Form were administered.

Results: The mean score of quality of life was 67.80 ± 13.44 on a 100-point scale. General self-efficacy (β = 0.340, P < 0.001), diabetes distress (β = -0.266, P < 0.001), and diabetes empowerment ability (β = 0.207, P < 0.001) were predictors of quality of life. In contrast, other factors including HbA1c, diabetes complications, and the duration of diabetes were not associated with quality of life (P > 0.05).

Conclusions: Our study indicated that psychosocial factors such as self-efficacy, diabetes distress, and diabetes empowerment ability are related to quality of life. Assessment and interventions aimed at reducing psychosocial problems should be applied in diabetes care.
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http://dx.doi.org/10.1007/s00592-015-0832-yDOI Listing
August 2016

Applying best practices to designing patient education for patients with end-stage renal disease pursuing kidney transplant.

Prog Transplant 2015 Mar;25(1):77-84

University of Missouri-St Louis.

Despite the known benefits of kidney transplant, less than 30% of the 615 000 patients living with end-stage renal disease (ESRD) in the United States have received a transplant. More than 100 000 people are presently on the transplant waiting list. Although the shortage of kidneys for transplant remains a critical factor in explaining lower transplant rates, another important and modifiable factor is patients' lack of comprehensive education about transplant. The purpose of this article is to provide an overview of known best practices from the broader literature that can be used as an evidence base to design improved education for ESRD patients pursuing a kidney transplant. Best practices in chronic disease education generally reveal that education that is individually tailored, understandable for patients with low health literacy, and culturally competent is most beneficial. Effective education helps patients navigate the complex health care process successfully. Recommendations for how to incorporate these best practices into transplant education design are described. Providing more ESRD patients with transplant education that encompasses these best practices may improve their ability to make informed health care decisions and increase the numbers of patients interested in pursuing transplant.
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http://dx.doi.org/10.7182/pit2015415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489708PMC
March 2015

A computer-based education intervention to enhance surrogates' informed consent for genomics research.

Am J Crit Care 2015 Mar;24(2):148-55

Ann K. Shelton is an assistant professor, Department of Primary Care Nursing, School of Nursing, Southern Illinois University Edwardsville. Bradley D. Freeman is a professor, Division of General Surgery, Acute and Critical Care Surgery Section, Washington University School of Medicine, St Louis, Missouri. Anne F. Fish and Jean A. Bachman are associate professors, College of Nursing, and Lloyd I. Richardson is the Curator's Teaching Professor, College of Education, University of Missouri-St Louis, St Louis, Missouri.

Background: Many research studies conducted today in critical care have a genomics component. Patients' surrogates asked to authorize participation in genomics research for a loved one in the intensive care unit may not be prepared to make informed decisions about a patient's participation in the research.

Objectives: To examine the effectiveness of a new, computer-based education module on surrogates' understanding of the process of informed consent for genomics research.

Methods: A pilot study was conducted with visitors in the waiting rooms of 2 intensive care units in a Midwestern tertiary care medical center. Visitors were randomly assigned to the experimental (education module plus a sample genomics consent form; n = 65) or the control (sample genomics consent form only; n = 69) group. Participants later completed a test on informed genomics consent.

Results: Understanding the process of informed consent was greater (P = .001) in the experimental group than in the control group. Specifically, compared with the control group, the experimental group had a greater understanding of 8 of 13 elements of informed consent: intended benefits of research (P = .02), definition of surrogate consenter (P= .001), withdrawal from the study (P = .001), explanation of risk (P = .002), purpose of the institutional review board (P = .001), definition of substituted judgment (P = .03), compensation for harm (P = .001), and alternative treatments (P = .004).

Conclusions: Computer-based education modules may be an important addition to conventional approaches for obtaining informed consent in the intensive care unit. Preparing patients' family members who may consider serving as surrogate consenters is critical to facilitating genomics research in critical care.
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http://dx.doi.org/10.4037/ajcc2015983DOI Listing
March 2015

Bath Salt-Induced Psychosis: Nursing Assessment, Diagnosis, Treatment, and Outcomes.

Perspect Psychiatr Care 2016 Jan 26;52(1):68-78. Epub 2015 Jan 26.

Pharmacy Department, St. Anthony's Medical Center, St. Louis, Missouri, USA.

Purpose: To review what is known about the assessment, diagnosis, treatment, and outcomes of patients with bath salt-induced psychosis.

Design And Methods: Comprehensive review and synthesis of research, case reports, and state-level data.

Findings: Of the 42 case reports found, only 18 confirmed the presence of bath salts through laboratory testing. Twelve of the confirmed cases died. In most of the case reports, law enforcement was involved prior to hospitalization due to bizarre behaviors, delusions, and hallucinations.

Practice Implications: Due to the severity of both physical and psychological symptoms in patients in bath salt-induced psychosis, nurses, other healthcare providers, police, and hospital security personnel must work collaboratively to provide safe care.
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http://dx.doi.org/10.1111/ppc.12101DOI Listing
January 2016

Nursing Student Research Assistant Program: A strategy to enhance nursing research capacity building in a Magnet status pediatric hospital.

Appl Nurs Res 2011 May 15;24(2):110-3. Epub 2009 Oct 15.

St. Louis Children's Hospital, One Children's Place, St. Louis, MO 63110, USA.

For busy clinicians, time to conduct research is scarce. A novel solution, the Nursing Student Research Assistant Program (NS-RAP), was designed in collaboration with area nursing schools to build research capacity at a pediatric hospital. Undergraduate and graduate nursing students participated in a variety of research experiences that, in turn, aided the conduct of clinician-initiated research at the pediatric hospital. In this article, conceptualization, implementation, outcomes, challenges, and future directions of NS-RAP are discussed.
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http://dx.doi.org/10.1016/j.apnr.2009.08.004DOI Listing
May 2011

Systematic review of educational interventions for improving advance directive completion.

J Nurs Scholarsh 2010 Sep;42(3):234-41

Epsilon Eta, Assistant Professor, School of Nursing, Southern Illinois University-Edwardsville, Edwardsville, IL, USA.

Purpose: To systematically analyze evidence about the outcome and percent of newly completed ADs, focusing on the effectiveness of (a) types of educational interventions versus controls and (b) one educational intervention over another.

Design: Systematic review of literature based on Cochrane review criteria.

Methods: Twelve randomized and four nonrandomized studies were selected from the nursing, medical, and social work literature that met the following criteria: described educational interventions, provided information to calculate the percent of newly completed ADs as an outcome, and published between 1991 and 2009. The review focused primarily on randomized studies. Reviewers calculated the percent of newly completed ADs by determining the number of subjects per group without an AD at baseline and the percentage of those who then completed one by the end of the studies.

Findings: Findings were inconsistent regarding all types of educational interventions studied versus controls. Sufficient evidence exists to conclude that combined written and verbal educational interventions were more effective than single written interventions in increasing the percent of newly completed ADs in adult clinic outpatients and hospitalized elderly.

Conclusions: Calculating the percent of newly completed ADs was successful in allowing for study result comparisons. Overall, the evidence base regarding the effectiveness of single or combined educational interventions in increasing AD completion is weak. Randomized studies with diverse samples should be conducted against controls before more studies comparing interventions are undertaken.

Clinical Relevance: This article provides nurses with a summary of research related to educational interventions and AD completion and identifies where future study is needed.
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http://dx.doi.org/10.1111/j.1547-5069.2010.01357.xDOI Listing
September 2010

Construct validity of four exercise stage of change measures in adults.

Res Nurs Health 2010 Jun;33(3):254-64

Mennonite College of Nursing, Illinois State University, Normal, IL 61790-5810, USA.

Measuring readiness to exercise, or exercise stage of change (ESOC), is an important first step when counseling adults about exercise. However, minimal construct validity testing of ESOC measures has been reported. With a sample of 95 adults, we estimated the construct validity of four ESOC measures with commonly used response formats (true/false, ladder, 5 choice, interview). Participants completed all four ESOC measures in random order as well as six validation measures: physical activity performed, exercise self-efficacy, decisional balance pros and cons, and behavioral and experiential processes of change. Few participants were in the earliest stage of change. The true/false measure demonstrated the strongest validity. Further studies are needed in diverse samples with more representation across the stages of change.
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http://dx.doi.org/10.1002/nur.20380DOI Listing
June 2010

Feasibility and acceptability of stepping exercise for cardiovascular fitness in women.

Appl Nurs Res 2009 Nov 15;22(4):274-9. Epub 2009 Jan 15.

College of Nursing, University of Missouri-St. Louis, St. Louis, MO 63121, USA.

Nurses conducting clinical research often test the feasibility and acceptability of interventions before using them in large-scale experimental studies. This article specifically reviews stepping exercise as an intervention with women. In a literature review, three stepping modes (steptreadmill, bench/step, and stepper) were compared, with the steptreadmill being identified as the most advantageous for use in experimental research. An exemplar was constructed to illustrate feasibility and acceptability of steptreadmill exercise (motorized stair climbing) in 11 women with hypertension. Steptreadmill exercise is feasible and acceptable and shows promise for use in experimental studies where strict control over the exercise performed is required.
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http://dx.doi.org/10.1016/j.apnr.2008.03.006DOI Listing
November 2009

Surrogate consent for genomics research in intensive care.

Am J Crit Care 2009 Sep;18(5):418-26; quiz 427

ITT-Technical Institute, St Louis, Missouri, USA.

Surrogate decision makers may be poorly prepared to give informed consent for genomics research for their loved ones in intensive care. A review of the challenges and strategies associated with obtaining surrogates' consent for genomics research in intensive care patients revealed that few well-controlled studies have been done on this topic. Yet, a major theme in the literature is the role of health care professionals in guiding surrogates through the informed consent process rather than simply witnessing a signature. Informed consent requires explicit strategies to approach potential surrogates effectively, educate them, and ensure that informed consent has been attained.
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http://dx.doi.org/10.4037/ajcc2009473DOI Listing
September 2009

Stage-specific education/counseling intervention in women with elevated blood pressure.

Prog Cardiovasc Nurs 2009 Jun;24(2):45-52

The Ohio State University College of Nursing, Columbus, OH 43210, USA.

Many women with elevated blood pressure who seek exercise opportunities require a flexible program with systematic follow-up. The study framework included motivational readiness (exercise stage of change) from the Transtheoretical Model and self-efficacy theory. This pilot study, which used a one-group repeated measures design, tested the feasibility of a stage-specific education/counseling intervention aimed at improving exercise outcomes in women with elevated blood pressure. Forty women completed a 2.5-hour session including prescription for moderate-vigorous exercise on their own, practice on equipment, maintenance of an exercise diary, and contracting; three follow-up calls (Weeks 1, 2, 3); a visit (Week 4); and a final call (Week 5). After the intervention, 85% of women moved to or remained in the action or maintenance stages of change, the highest levels of readiness; none relapsed. Exercise self-efficacy and benefits increased and barriers decreased (P<.05); 70% of participants increased exercise performance. The intervention was feasible. Further testing is warranted using larger samples and including a control group.
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http://dx.doi.org/10.1111/j.1751-7117.2009.00031.xDOI Listing
June 2009

Readiness to exercise: a comparison of 3 instruments and an interview.

Prog Cardiovasc Nurs 2007 ;22(4):201-6

College of Nursing, University of Missouri-St Louis, St Louis, MO 63121, USA.

Exercise stage of change (ESOC), or readiness to exercise, has been measured using at least 13 instruments and 4 interviews, yet no comparison studies are available to determine optimal measures for use by health care providers. This pilot study compares ESOC classification between 3 instruments (scale-ladder, scale-true/false, and scale-5 choice); explores the feasibility of using a face-to-face structured interview; compares classification between instruments and interview; and examines the influence of sex, age, and education level on stage classification. Thirty healthy adults completed ESOC instruments in random order and then the interview. Scale-ladder and scale-true/false instruments exhibited almost perfect agreement (weighted kappa, 0.897). All instruments exhibited substantial agreement with interview (weighted kappa, 0.620-0.790). Stage classification did not differ significantly by sex, age, or education level. The authors recommend word clarification revision of the scale-5 choice instrument and further testing of the interview.
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http://dx.doi.org/10.1111/j.0889-7204.2007.06494.xDOI Listing
February 2008