Publications by authors named "Chiahui Chen"

12 Publications

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Instruments to measure e-cigarette related constructs: a systematic review.

BMC Public Health 2022 06 7;22(1):1135. Epub 2022 Jun 7.

University at Buffalo, School of Nursing, 3435 Main St. University at Buffalo, Wende Hall, Buffalo, NY, 14214-8013, USA.

Background: Electronic cigarettes (e-cigarettes) are relatively new tobacco products that are attracting public attention due to their unique features, especially their many flavor options and their potential as an alternative to cigarettes. However, uncertainties remain regarding the determinants and consequences of e-cigarette use because current research on e-cigarettes is made more difficult due to the lack of psychometrically sound instruments that measure e-cigarette related constructs. This systematic review therefore seeks to identify the instruments in the field that are designed to assess various aspects of e-cigarette use or its related constructs and analyze the evidence presented regarding the psychometric properties of the identified instruments.

Methods: This systematic review utilized six search engines: PubMed, Medline, CINAHL, PsycINFO, Web of Science, and EMBASE, to identify articles published in the peer-reviewed journals from inception to February 2022 that contained development or validation processes for these instruments.

Results: Eighteen articles describing the development or validation of 22 unique instruments were identified. Beliefs, perceptions, motives, e-cigarette use, and dependence, were the most commonly assessed e-cigarette related constructs. The included studies reported either construct or criterion validity, with 14 studies reporting both. Most studies did not report the content validity; for reliability, most reported internal consistencies using Cronbach's alpha, with 15 instruments reporting Cronbach's alpha > 0.70 for the scale or its subscales.

Conclusions: Twenty-two instruments with a reported development or validation process to measure e-cigarette related constructs are currently available for practitioners and researchers. This review provides a guide for practitioners and researchers seeking to identify the most appropriate existing instruments on e-cigarette use based on the constructs examined, target population, psychometric properties, and instrument length. The gaps identified in the existing e-cigarette related instruments indicate that future studies should seek to extend the validity of the instruments for diverse populations, including adolescents. Instruments that explore additional aspects of e-cigarette use and e-cigarette related constructs to help build a strong theoretical background and expand our current understanding of e-cigarette use and its related constructs, should also be developed.
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June 2022

Corrigendum to "Burnout and depression in nurses - A systematic review and meta-analysis" [International Journal of Nursing Studies, Volume 124 (2021) 104099].

Int J Nurs Stud 2022 Mar 4;127:104180. Epub 2022 Feb 4.

School of Nursing, University at Buffalo, and Department of Counseling, School & Educational Psychology, University at Buffalo.

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March 2022

COMFORT communication in the ICU: Pilot test of a nurse-led communication intervention for surrogates.

J Clin Nurs 2021 Nov 22. Epub 2021 Nov 22.

School of Nursing, University at Buffalo - The State University of New York, Buffalo, New York, USA.

Aim: This study was designed to investigate the feasibility, acceptability, and preliminary efficacy of a nurse-led communication intervention among surrogates in the intensive care unit (ICU) guided by the COMFORT (Connect; Options; Making meaning; Family caregivers; Openings; Relating; Team) communication model.

Background: As frontline communicators, nurses experience communication difficulties with surrogates who face complex informational and emotional barriers when making decisions for critically ill patients in the ICU. However, research on effective nurse communication focusing on both curative and end-of-life (EOL) care is lacking in the literature.

Design: A single-centre two-group pretest-posttest quasi-experiment.

Method: The total sample included 41 surrogates of adult ventilated patients. Twenty participants were allocated to the intervention group who received a daily 20-min telephone call with content based on the COMFORT communication model. Twenty-one participants comprised the control group who received usual care. Participants completed a questionnaire before and after the study measuring satisfaction, anxiety and depression, decisional conflict, and quality of communication. The Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist was followed for nonrandomised controlled trials.

Result: The intervention was feasible, with 19 of 20 surrogates completing the follow-up surveys, and 48 telephone conversations completed (48% of the planned phone calls). Surrogates' satisfaction was higher in the intervention group than in the control group after adjusting for the selected covariates (25.43 and 24.15, respectively; p = .512). Preliminary efficacy outcomes favouring the intervention included quality of communication with healthcare providers, but not surrogates' perceived depression/anxiety and decisional conflicts.

Conclusion: Implementation of the intervention is feasible, acceptable, and favourable among surrogates to improve quality of communication with healthcare providers in the ICU. Further research is needed to determine whether the intervention could be implemented by nurses to improve surrogates' outcomes in other ICUs.
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November 2021

Burnout and depression in nurses: A systematic review and meta-analysis.

Int J Nurs Stud 2021 Dec 1;124:104099. Epub 2021 Oct 1.

Department of Counseling, School and Educational Psychology, University at Buffalo - The State University of New York, Buffalo, NY, United States of America.

Background: Nurses work in stressful and demanding settings and often suffer from depression and burnout. Despite overlapping symptoms, research has been inconclusive regarding the discriminant validity of measures of burnout with regard to measures of depression. Such inconclusive discriminant validity might cause clinicians to fail to recognize and manage depression separately from burnout.

Objectives: This meta-analysis aimed to clarify the distinctiveness of burnout as a separate construct by examining the size of the relationship between burnout and depression among nurses as well as potential moderators.

Method: A stepwise method was used by searching 4 databases (PubMed, CINAHL, PsycINFO, and EMBASE) to retrieve published papers in English examining the relationship between burnout and depression among nurses and reporting the effect sizes of their findings.

Results: We identified a total of 37 eligible studies. The pooled estimate showed a positive association between burnout and depression among nurses (r = 0.403, 95% CI [0.327, 0.474], p < 0.0001) and a slightly higher correlation coefficient for the Emotional Exhaustion subscale of the Maslach Burnout Inventory (MBI) measure (0.494, 95% CI [0.41, 0.57]).

Conclusions And Implications: This review confirms a large burnout - depression correlation in nursing samples, adding to existing literature encompassing a variety of occupations. Future studies should focus on path analysis to assess the causal relationship as well as investigate potential moderators.
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December 2021

Navigating the caregiving abyss: A metasynthesis of how family caregivers manage end-of-life care for older adults at home.

Palliat Med 2022 Jan 3;36(1):81-94. Epub 2021 Sep 3.

School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY, USA.

Background: Demographic changes (global aging, decreased fertility, increased home deaths) will present a critical need for end-of-life family caregivers of older adults at home. In order to support these family caregivers, we need to better understand their experiences, struggles, and needs.

Aim: To describe and explain the process of end-of-life caregiving as experienced by family caregivers of older adults residing in the home setting.

Design: The Preferred Reporting Items for Systematic Reviews and Metaanalysis (PRISMA) guidelines and Sandelowski and Barroso's procedural steps for a metasynthesis review guided this study.

Data Sources: Qualitative and mixed methods literature from CINAHL, Medline, PsycINFO, and EMBASE databases and information from professional organizations were reviewed for studies that focused on family caregivers providing end-of-life care to older adults residing in the home setting.

Results: A total of 24 studies were identified. Family caregivers engaged in the process of "navigating a caregiving abyss" when providing and managing end-of-life-care for older adults at home. The "caregiving abyss" consisted of four phases: (1) managing multiple roles, (2) encountering challenges, (3) mobilizing resources, and (4) acknowledging death is near. During the process family caregivers strived to "live day by day" and "maintain normalcy" to achieve the goals of honoring life's final wishes and provide home death.

Conclusion: Family caregivers of older adults at the end of life navigate a variety of challenges. The findings provide a conceptual framework to help guide the development of education, interventions, and health policy to meet family caregivers' needs in providing quality end-of-life care.
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January 2022

COVID 19-transformed nursing education and communication competency: Testing COMFORT educational resources.

Nurse Educ Today 2021 Dec 19;107:105105. Epub 2021 Aug 19.

Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA.

Background: The COVID-19 pandemic brought a disruption to nurse education for both nursing faculty and students as all non-clinical nurse education courses worldwide moved to distance or online learning. The sudden shift to online education meant the loss of traditional activities for students to learn communication skills creating a critical demand for open educational resources for students and nursing faculty. Tools to support nursing faculty development for teaching communication are nearly non-existent and pedagogical content knowledge is needed.

Objectives: The purpose of this study was to test two COMFORT COVID-19 Communication Modules (PPE and Video/Phone) for undergraduate nursing students and evaluate student communication competency post-intervention.

Design: This pre-post study includes qualitative and quantitative data collected to evaluate student communication competency post-intervention.

Settings: Undergraduate Bachelor of Science in Nursing (BSN) students at four university campuses in the Pacific and MidSouth regions of the United States.

Participants: BSN nursing students (n = 197) predominantly in the third year of study (n = 138, 70%).

Methods: Students completed online modules as part of a nursing course. Faculty provided information and a link to access online learning modules. A pre-post assessment was completed for each module.

Results: Significant statistical differences were found across variables of communication attitude, knowledge, and skill across both modules.

Conclusions: As nursing education in the United States shifts to competency-based education which emphasizes skill development across the BSN program, it is imperative to establish communication learning objectives that are measurable and ensure communication theory and evidence-based practice is part of curriculum content.
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December 2021

The Experiences of Family Members of Ventilated COVID-19 Patients in the Intensive Care Unit: A Qualitative Study.

Am J Hosp Palliat Care 2021 Jul 1;38(7):869-876. Epub 2021 Apr 1.

School of Nursing, 12292University at Buffalo-The State University of New York, Buffalo, NY, USA.

Background: Visitor restrictions caused challenges for family members when their loved ones had coronavirus disease (COVID-19) and were ventilated. Limited studies have reported on family members' experiences and support needs.

Aim: To explore the experiences and support needs of family members of ventilated COVID-19 patients in the intensive care unit (ICU).

Design: Exploratory, qualitative design, using in-depth individual telephone interviews, and analyzed using thematic analysis.

Setting/participants: Ten family members of adult COVID-19 patients in the ICU.

Result: Seven key themes represented family members' experiences: (a) reactions to the COVID-19 diagnosis, (b) COVID-19 as a destabilizing force on the family unit, (c) COVID-19's effects on bereavement outcomes, (d) desperately seeking information, (e) family member needs, (f) conflicting feelings about video calls, and (g) appreciation of care. Family members' feelings about the patient's diagnosis and how the virus was contracted exacerbated their stress and anxiety. They struggled to feel informed about care that they could not witness and had difficulty understanding information. Family members reported that video calls were unhelpful. While these experiences made them question the quality of care, they expressed their appreciation of the frontline healthcare providers taking care of their loved ones.

Conclusion: The stress and uncertainty of family members of critically ill patients with COVID-19 were influenced by their inability to feel connected to the patient and informed about care. Healthcare providers should assess each individual family's burden and preferences, and this should include establishing structured, timely, and consistent communication regarding patient care during the pandemic including early referral to palliative care.
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July 2021

Opportunities to improve COVID-19 provider communication resources: A systematic review.

Patient Educ Couns 2021 03 9;104(3):438-451. Epub 2021 Jan 9.

From California State University Los Angeles, Patricia A. Chin School of Nursing, Los Angeles CA, USA.

Objective: Communication related to COVID-19 between provider and the patient/family is impacted by isolation requirements, time limitations, and lack of family/partner access. Our goal was to determine the content of provider communication resources and peer-reviewed articles on COVID-19 communication in order to identify opportunities for developing future COVID-19 communication curricula and support tools.

Methods: A systematic review was conducted using the UpToDate clinical decision support resource database, CINAHL, PubMed, PsycInfo, and Web of Science. The grey literature review was conducted in September 2020 and articles published between January-September 2020 written in English were included.

Results: A total of 89 sources were included in the review, (n = 36 provider communication resources, n = 53 peer-reviewed articles). Resources were available for all providers, mainly physicians, and consisted of general approaches to COVID-19 communication with care planning as the most common topic. Only four resources met best practices for patient-centered communication. All but three articles described physician communication where a general emphasis on patient communication was the most prevalent topic. Reduced communication channels, absence of family, time, burnout, telemedicine, and reduced patient-centered care were identified as communication barriers. Communication facilitators were team communication, time, patient-centered and family communication, and available training resources.

Conclusions: Overall, resources lack content that address non-physician providers, communication with family, and strategies for telehealth communication to promote family engagement. The gaps identified in this review reveal a need to develop more materials on the following topics: provider moral distress, prevention communication, empathy and compassion, and grief and bereavement. An evidence-base and theoretical grounding in communication theory is also needed.

Practice Implications: Future development of COVID-19 communication resources for providers should address members of the interdisciplinary team, communication with family, engagement strategies for culturally-sensitive telehealth interactions, and support for provider moral distress.
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March 2021

Healthcare Shift Workers' Temporal Habits for Eating, Sleeping, and Light Exposure: A Multi-Instrument Pilot Study.

J Circadian Rhythms 2020 Oct 21;18. Epub 2020 Oct 21.

School of Nursing, University at Buffalo, Buffalo, NY, US.

Background: Circadian misalignment can impair healthcare shift workers' physical and mental health, resulting in sleep deprivation, obesity, and chronic disease. This multidisciplinary research team assessed eating patterns and sleep/physical activity of healthcare workers on three different shifts (day, night, and rotating-shift). To date, no study of real-world shift workers' daily eating and sleep has utilized a largely-objective measurement.

Method: During this fourteen-day observational study, participants wore two devices (Actiwatch and Bite Technologies counter) to measure physical activity, sleep, light exposure, and eating time. Participants also reported food intake via food diaries on personal mobile devices.

Results: In fourteen (5 day-, 5 night-, and 4 rotating-shift) participants, no baseline difference in BMI was observed. Overall, rotating-shift workers consumed fewer calories and had less activity and sleep than day- and night-shift workers. For eating patterns, compared to night- and rotating-shift, day-shift workers ate more frequently during work days. Night workers, however, consumed more calories at work relative to day and rotating workers. For physical activity and sleep, night-shift workers had the highest activity and least sleep on work days.

Conclusion: This pilot study utilized primarily objective measurement to examine shift workers' habits outside the laboratory. Although no association between BMI and eating patterns/activity/sleep was observed across groups, a small, homogeneous sample may have influenced this. Overall, shift work was associated with 1) increased calorie intake and higher-fat and -carbohydrate diets and 2) sleep deprivation. A larger, more diverse sample can participate in future studies that objectively measure shift workers' real-world habits.
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October 2020

Transitional Care Models for High-Need, High-Cost Adults in the United States: A Scoping Review and Gap Analysis.

Prof Case Manag 2021 Mar-Apr 01;26(2):82-98

Sharon Hewner, PhD, RN, FAAN, is a faculty in the Department of the Family, Community and Health Systems Science Department in the University at Buffalo School of Nursing. Her research focuses on implementing technology-supported care management interventions to improve transitional care for persons with social needs and multiple chronic conditions.

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October 2021

Family Outcomes and Perceptions of End-of-Life Care in the Intensive Care Unit: A Mixed-Methods Review.

J Palliat Care 2020 Jul 23;35(3):143-153. Epub 2019 Sep 23.

School of Nursing, University at Buffalo-The State University of New York, Buffalo, NY, USA.

The purpose of this review was to evaluate end-of-life care (EOLC) in the intensive care unit (ICU) from the perspective of family members. Sandelowski's segregated approach from Joanna Briggs Institute (JBI) Mixed-Methods Systematic Reviews guided this review. A search was conducted in PubMed, CINAHL, PsycINFO, EMBASE, and ProQuest databases and identified 50 papers (33 quantitative, 15 qualitative, and 2 mixed-methodology studies). Five synthesized themes (distressing emotions, shared decision-making, proactive communication, personalized end-of- life care, and valuing of nursing care) were identified. For quantitative results, study methodologies and interventions were heterogeneous and did not always improve family members' perceived quality of care and family members' psychological distress. Configuration of qualitative and quantitative data revealed ICU end-of-life interventions were ineffective because they were not guided by family members' reported needs and perceptions. To fulfill the family members' needs for the patients' EOLC in the ICU, researchers should develop a theory to explicitly explain how the family members experience ICU EOLC and implement a theory-based intervention to improve family psychological outcomes.
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July 2020

Selecting the Best Instrument to Measure Family Perceptions of End-of-Life Communication in Intensive Care Units.

Am J Hosp Palliat Care 2020 Feb 7;37(2):154-160. Epub 2019 Aug 7.

Department of Counseling, School and Educational Psychology, University at Buffalo, The State University of New York, Buffalo, NY, USA.

Background: Good communication with the family is a clinical imperative for high quality end-of-life (EOL) care in intensive care unit (ICU). Many interventions aim to improve EOL communication, and the choice of an outcome instrument has important implications for evaluating interventions. The purpose of this project is to search and review available instruments' psychometric properties and determine which best measures family-clinician communication in the ICU.

Method: A stepwise method was used by searching 2 databases (PsycInfo and Web of Science) to identify instruments and articles that provide information about scale psychometric properties.

Instruments: Three instruments were identified, including Family Inpatient Communication Survey, Family Perception of Physician-Family Caregiver Communication, and Quality of Communication (QOC).

Results: Reliability estimates were high (≥ 0.79) in all 3 instruments. The QOC's convergent validity estimates exceed its discriminant validity values, and the QOC is an intervention-sensitive measure used to examine families' treatment response in randomized control trials.

Conclusion: Quality of Communication is the most suitable instrument to measure family's perceptions of EOL communication in the ICU. Quality of Communication scores provide a deeper understanding of family-clinician communication and data about how to improve EOL care in ICUs.
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February 2020