Publications by authors named "Ronald L Hickman"

61 Publications

Decision fatigue among clinical nurses during the COVID-19 pandemic.

J Clin Nurs 2021 Jul 21. Epub 2021 Jul 21.

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

Aims And Objectives: The purpose of this study was to report the psychometric properties, including validity and reliability, of the decision fatigue scale (DFS).

Background: Decision fatigue may impair nurses' ability to make sound clinical decisions and negatively impact patient care. Given the negative impact of the COVID-19 pandemic on psychological well-being and the workplace environment, decision fatigue may be even more apparent among clinical nurses. Valid assessment of this condition among clinical nurses may inform supportive interventions to mitigate the negative sequelae associated with states of decision fatigue.

Design: This study was a secondary analysis of a parent study using a cross-sectional descriptive design.

Methods: A convenience sample of 160 staff nurses was recruited online from across the United States. Participants completed a demographic questionnaire and subjective measures of decision fatigue, nursing practice environment scale and traumatic stress. Exploratory factor analysis (EFA), correlation coefficients and internal consistency reliability coefficients were computed to examine the DFS's validity and reliability within this sample.

Results: The EFA yielded a single factor, 9-item version of the DFS. The DFS scores were strongly correlated with traumatic stress and moderately correlated with the nursing practice environment, and the scale displayed appropriate internal consistency.

Conclusions: This is the first known study to provide evidence of the DFS's validity and reliability in a sample of registered nurses working during the COVID-19 pandemic. The results of this study provide evidence of a reliable and valid assessment instrument for decision fatigue that can be used to measure the burden of decision-making among registered nurses.

Relevance To Clinical Practice: Given the relationship between traumatic stress and the nursing work environment, decision fatigue may be a modifiable target for interventions that can enhance the quality of decision-making among clinical nurses.
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http://dx.doi.org/10.1111/jocn.15939DOI Listing
July 2021

Structural Validity of the Hospital Anxiety and Depression Scale Among Family Members of Critically Ill Patients.

Am J Crit Care 2021 05;30(3):212-220

Ronald L. Hickman Jr is an associate professor of nursing and associate dean for research, Frances Payne Bolton School of Nursing, Case Western Reserve University.

Background: The Hospital Anxiety and Depression Scale (HADS) is commonly used clinically and scientifically among surrogate decision makers for critically ill patients. The validity of the HADS has been scrutinized, but its use among surrogate decision makers has not been examined.

Objective: To examine the structural validity of the HADS.

Methods: This study was a secondary analysis of data obtained from a 3-arm randomized controlled trial of a decision support intervention. Participants were recruited from 6 intensive care units at a tertiary medical center in Northeast Ohio. Participants were adult surrogate decision makers for critically ill, cognitively impaired adults who were not expected to be discharged from the intensive care unit within the subsequent 48 hours. The fit of 2-factor, 3-factor, and bifactor structures of the HADS was tested with confirmatory factor analysis.

Results: The bifactor structure, possessing a general psychological distress factor and anxiety and depression group factors, showed a superior fit and met a priori thresholds for acceptable model fit. The general psychological distress factor accounted for more than 75% of the common variance in the HADS items.

Conclusion: Confirmatory factor analysis provided evidence supporting a bifactor structure of the HADS. In this sample, the instrument validly measures psychological distress rather than distinct symptoms of anxiety and depression. Replication of these results is encouraged, and use of alternative measures is recommended when measuring distinct symptoms of anxiety and depression among surrogate decision makers for critically ill patients.
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http://dx.doi.org/10.4037/ajcc2021214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270500PMC
May 2021

Circadian characteristics of the rest-activity rhythm, executive function, and glucose fluctuations in young adults with type 1 diabetes.

Chronobiol Int 2021 Jun 15:1-11. Epub 2021 Jun 15.

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

Circadian alignment is an important element in individual health, and one behavioral marker, rest-activity rhythm, could influence self-management in young adults with type 1 diabetes (T1D). Little is known about the rest-activity rhythms, executive function, and glycemia among young adults with type 1 diabetes (T1D). The purpose of this study was to evaluate parametric and nonparametric circadian characteristics of the rest-activity rhythm and the associations between these variables, sleep-wake behavior, executive function, and glycemia among young adults with T1D. Young adults with T1D, recruited from diabetes clinics, wore wrist actigraphs and a continuous glucose monitor (CGM) concurrently for 6-14 days. Participants completed a 3-minute Trail Making Test on paper and electronic questionnaires - 8-item PROMIS v1.0 Emotional Distress Scale, 17-item Diabetes Distress Scale, including twice-daily Pittsburgh sleep diaries. Cosinor and nonparametric analyses were used to compute the rest-activity rhythm parameters, and linear regression modeling procedures were performed to determine the associations among the study variables. The sample included 46 young adults (mean age 22.3 ± 3.2; 32.6% male; 84.8% non-Hispanic White, HbA1c mean 7.2 ± 1.1%, BMI mean 27.0 ± 4.4 kg/m). A number of parametric associations were observed between a stronger rhythm, better objective sleep-wake characteristics, and less daytime sleepiness. Nonparametric circadian parameters were significantly associated with several outcomes: a stronger rhythm adherence (higher inter-daily stability) with better objective sleep-wake characteristics, better executive function, lower diabetes distress, less hyperglycemia risk, and more time spent in hypoglycemia/hypoglycemia risk; and a more robust rhythm (higher relative amplitude) with better objective sleep-wake characteristics and more time spent in hypoglycemia/higher hypoglycemia risk. Future work should be directed at designs that test causality, such as interventions directed at the strength and stability of rest-activity rhythms, for the potential to improve glucoregulation and other diabetes outcomes.
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http://dx.doi.org/10.1080/07420528.2021.1932987DOI Listing
June 2021

Sleep Interventions for Informal Caregivers of Persons with Dementia: A Systematic Review.

West J Nurs Res 2021 Jun 4:1939459211019033. Epub 2021 Jun 4.

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

We conducted a systematic review on the state of the science related to sleep interventions for informal caregivers of persons with Alzheimer's disease or related dementia (ADRD). This review included English-written, peer-reviewed articles that studied the effect of an intervention on sleep health outcomes for informal caregivers of persons with ADRD. Our search yielded 15 articles that met our a priori inclusion criteria. We categorized interventions into four categories: environmental, physical, cognitive, and collaborative. Intervention effects were heterogeneous, with most yielding nonsignificant sleep health effects. There is a need for theoretically sound and robust sleep health interventions for informal caregiver samples. Future research in this area could benefit from the use of more controlled, pragmatic, and adaptive research designs, and the use of objective measures that conceptually represent the multiple domains of sleep health to enhance intervention quality.
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http://dx.doi.org/10.1177/01939459211019033DOI Listing
June 2021

Family Caregivers' Experiences and Changes in Caregiving Tasks During the COVID-19 Pandemic.

Clin Nurs Res 2021 May 17:10547738211014211. Epub 2021 May 17.

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

The purpose of this descriptive study was to describe family caregivers' experiences and changes in caregiving tasks and approaches during the COVID-19 pandemic. Using web-based strategies, 69 family caregivers of adults with chronic or disabling conditions were recruited and completed an online survey about positive and negative caregiving experiences, and ways in which caregiving has changed. Data were analyzed using descriptive statistics (structured questions) and conventional content analysis (open-ended responses). Participants reported concerns about their loved one's physical and mental health, the limited access to other caregiving sources, and the limited opportunities to maintain personal well-being. Caregiving tasks completed more than usual included providing emotional support, shopping for groceries and essentials, and contacting healthcare providers. Participants modified their caregiving approach by assuming added responsibilities, leveraging technology, and managing a new caregiving routine. Findings indicate that family caregivers experienced additional caregiving challenges and changed caregiving tasks considering the limited resources available.
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http://dx.doi.org/10.1177/10547738211014211DOI Listing
May 2021

Effects of an eHealth Intervention on Patient-Provider Interaction and Functional Health Literacy in Adults With Hypertension.

SAGE Open Nurs 2021 Jan-Dec;7:23779608211005863. Epub 2021 Apr 27.

School of Nursing, King AbdulAziz University, Jeddah, Saudi Arabia.

Introduction: Hypertension is a life-limiting, chronic condition affecting millions of Americans. Modifiable factors, quality of the patient-provider interaction and functional health literacy, have been linked to effective hypertension self-management. However, there has been limited interventional research targeting these modifiable factors. Electronic hypertension self-management interventions, in particular those incorporating virtual simulation, may positively influence the quality of the patient-provider interaction and functional health literacy status of adults with hypertension. Yet there is a dearth of evidence examining the efficacy of eHealth interventions targeting these modifiable factors of hypertension self-management.

Objective: Evaluate the effects of two electronic hypertension self-management interventions on the quality of the patient-provider interaction and functional health literacy in adults with hypertension.

Methods: A convenience sample of community-dwelling adults (>18 years) with hypertension were recruited and randomized to an avatar-based simulation (eSMART-HTN) or a video presentation on hypertension self-management (attention control). Participants were administered questionnaires to capture demographic characteristics, the quality of the patient-provider interaction, and functional health literacy. Questionnaire data were collected at baseline, and then monthly across three months. Two separate repeated measures analysis of covariance models were conducted to assess the effects of the interventions across the time points.

Results: The sample included 109 participants who were predominately middle-aged and older, nonwhite, and female. Scores for the quality of the patient-provider interaction demonstrated significant within-group changes across time. However, there were no significant differences in the quality of the patient-provider interaction or functional health literacy scores between experimental conditions while adjusting for covariates.

Conclusion: An avatar-based simulation (eSMART-HTN) intervention proved to have a positive effect on patient-provider interaction compared to an attention control condition. Although the results are promising, future research is needed to optimize the effectiveness of eSMART-HTN and enhance its efficacy and scalability in a larger cohort of adults with hypertension.
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http://dx.doi.org/10.1177/23779608211005863DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083006PMC
April 2021

Sleep-wake characteristics, daytime sleepiness, and glycemia in young adults with type 1 diabetes.

J Clin Sleep Med 2021 May 5. Epub 2021 May 5.

School of Nursing and School of Medicine, Yale University, West Haven, Connecticut.

Study Objectives: The purpose of this study was to describe objective sleep-wake characteristics and glycemia over 7 - 14 days in young adults with type 1 diabetes (T1D). Additionally, person level associations among objective sleep-wake characteristics (total sleep time, sleep variability, and sleep fragmentation index), daytime sleepiness, and glycemia (glycemic control and glucose variability) were examined.

Methods: In this cross-sectional study, objective sleep-wake characteristics were measured via actigraphy and glucose variability via continuous glucose monitoring (CGM) over 6-14 days. At baseline, participants completed a psychomotor vigilance test (PVT), Trail Making Test, and questionnaires on daytime sleepiness, sleep quality, and sleep disturbance including sleep diaries.

Results: Forty-six participants (mean age 22.3 ± 3.2 years) wore a wrist actigraph and CGM concurrently for 6-14 days. Greater sleep variability was directly associated with greater glucose variability (mean of daily differences) (r = 0.33, p = .036). Higher daytime sleepiness was directly associated with greater glucose variability (mean of daily differences) (r = 0.50, p = .001). The association between sleep variability and glucose variability (mean of daily differences) was no longer significant when accounting for daytime sleepiness and controlling for T1D duration (p > .05). A higher sleep fragmentation index was associated with greater glucose variability (B = 1.27, p = .010, pr = .40) after controlling for T1D duration and accounting for higher daytime sleepiness.

Conclusions: Sleep-wake variability, sleep fragmentation, daytime sleepiness, and the associations with glycemia are new dimensions to consider in young adults with T1D. Sleep habits in this population may explain higher glucose variability and optimizing sleep may improve overall diabetes management.
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http://dx.doi.org/10.5664/jcsm.9402DOI Listing
May 2021

Negative marital interaction, purpose in life, and depressive symptoms among middle-aged and older couples: evidence from the Health and Retirement Study.

Aging Ment Health 2021 Mar 26:1-10. Epub 2021 Mar 26.

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

Objective: Negative marital interaction and purpose in life have been associated with depressive symptoms. Yet, these associations have not been fully explored in a dyadic context. This study examines the actor (intra-individual) and partner (cross-spousal) effects of negative marital interaction on depressive symptoms in couples and the potential mediating role of purpose in life.

Methods: Data came from 1186 heterosexual married couples who participated in the 2016 (T1) and 2018 (T2) waves of the Health and Retirement Study and completed the psychosocial questionnaire in 2016. Structural equation modeling was used to estimate the direct and indirect associations among T1 negative marital interaction, T1 purpose in life, and T2 depressive symptoms at the actor and partner levels. Models controlled for age, race, educational level, self-rated health, and length of marriage.

Results: At the actor level, a greater negative marital interaction was associated with significantly lower levels of purpose in life for husbands and wives. Negative marital interaction was also associated with depressive symptoms for wives. Purpose in life mediated the relationship between negative marital interaction and depressive symptoms. At the partner level, wives' negative marital interaction was negatively associated with husbands' purpose in life, independent of husbands' own effects.

Conclusion: The findings support the dominant marital discord model of depression and highlight gender differences in the cross-spousal effects of negative marital interaction on purpose in life. Positive psychology interventions can be beneficial to promote purpose in life and subsequently improve mental health outcomes among couples.
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http://dx.doi.org/10.1080/13607863.2021.1904831DOI Listing
March 2021

Exploration of Decisional Control Preferences in Adolescents and Young Adults with Cancer and Other Complex Medical Conditions.

J Adolesc Young Adult Oncol 2020 08 24;9(4):464-471. Epub 2020 Feb 24.

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

Adolescent and young adults (AYA) with cancer encounter many medical treatment decisions but may have variable desires for involvement in decision-making. This study describes the degree of decisional control AYA patients preferred in complex medical decisions. A cross-sectional descriptive correlational design evaluated experienced AYA patients' decision-making role preferences using the Control Preference Scale and explored relationships in a proposed model of decision control. Overall, most patients preferred an "active collaborative" role (39%), where the patient prefers to make the final decision with input from the provider, or a "shared decision-making" role (34%), wherein the decision is jointly made between patient and provider. Oncology AYA patients tended to prefer a more passive role than nononcology AYA patients. Time since diagnosis also positively correlated with control preference, with patients preferring a more active level of decisional control as the number of days from diagnosis increased. While no other statistically significant relationships were found between factors put forth in the exploratory model and decision control, there were strong associations between the factors themselves that warrant future study. The findings advance the knowledge of AYA preferences for decision-making involvement, enhancing our ability to identify patients at risk for low health care engagement and explore the consequences of limited or impaired decisional capacity. Future research might examine interventions to promote self-management skills and patient decisional role preferences, fulfilling the need to respect both the desire for decision-making involvement of some patients and the preference to defer to the expertise of providers for others.
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http://dx.doi.org/10.1089/jayao.2019.0135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7640748PMC
August 2020

Systematic Review of Technology-Based Interventions Targeting Chronically Ill Adults and Their Caregivers.

West J Nurs Res 2020 11 16;42(11):974-992. Epub 2020 Jan 16.

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

The purpose of this systematic review is to synthesize the study design features as well as the attributes and outcomes of technology-based health interventions targeting chronically ill adults and their family caregivers. Twenty papers representing 19 studies met the inclusion criteria. Various theoretical foundations or approaches guided the interventions in 11 studies. Interventions either aimed to support patient self-management and improve patient outcomes or enhance shared illness management and improve patient and caregiver outcomes. The interventions included educational, behavioral, and support components and were delivered using various technologies ranging from text messaging to using the Internet. Overall, patients and caregivers expressed improvements in self-management outcomes (or support) and quality of life. Interventions with a dyadic focus reported on interpersonal outcomes, with improvements noted mostly in patients. This review captures an emerging area of science, and findings should be interpreted in light of the methodological limitations of the included studies.
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http://dx.doi.org/10.1177/0193945919897011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096122PMC
November 2020

A psychometric evaluation of the Family Decision-Making Self-Efficacy Scale among surrogate decision-makers of the critically ill.

Palliat Support Care 2020 10;18(5):537-543

Case Western Reserve University, Cleveland, OH.

Objectives: The purpose of this study was to report the psychometric properties, in terms of validity and reliability, of the Unconscious Version of the Family Decision-Making Self-Efficacy Scale (FDMSE).

Methods: A convenience sample of 215 surrogate decision-makers for critically ill patients undergoing mechanical ventilation was recruited from four intensive care units at a tertiary hospital. Cross-sectional data were collected from participants between days 3 and 7 of a decisionally impaired patient's exposure to acute mechanical ventilation. Participants completed a self-report demographic form and subjective measures of family decision-making self-efficacy, preparation for decision-making, and decisional fatigue. Exploratory factor analyses, correlation coefficients, and internal consistency reliability estimates were computed to evaluate the FDMSE's validity and reliability in surrogate decision-makers of critically ill patients.

Results: The exploratory factor analyses revealed a two-factor, 11-item version of the FDMSE was the most parsimonious in this sample. Furthermore, modified 11-item FDMSE demonstrated discriminant validity with the measures of fatigue and preparation for decision-making and demonstrated acceptable internal consistency reliability estimates.

Significance Of Results: This is the first known study to provide evidence for a two-factor structure for a modified, 11-item FDMSE. These dimensions represent treatment and palliation-related domains of family decision-making self-efficacy. The modified FDMSE is a valid and reliable instrument that can be used to measure family decision-making self-efficacy among surrogate decision-makers of the critically ill.
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http://dx.doi.org/10.1017/S1478951519000907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7205581PMC
October 2020

Comparing cognitive load levels among family members of the critically ill exposed to electronic decision aids.

Appl Nurs Res 2019 12 3;50:151192. Epub 2019 Sep 3.

Case Western Reserve University, Cleveland, OH, United States of America.

Cognitive load predicts one's ability to process information and learn from decision support interventions. The present study compared intrinsic and extraneous cognitive load levels resulting from exposure to two different electronic decision aids. A convenience sample of ninety-seven surrogate decision makers for critically ill patients were randomly assigned to receive either a single dose of a video-based or avatar-based decision aid. Intrinsic and extraneous cognitive load levels among recipients of the video-based decision support resource were lower than recipients of the avatar-based decision support resource. After controlling for age, the observed differences in intrinsic cognitive load were not significantly different, whereas the observed differences in extraneous cognitive load remained. Extraneous cognitive load is a modifiable factor to consider for future developers of decision support interventions that may determine the efficacy of efforts to support patients and family members with decision making.
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http://dx.doi.org/10.1016/j.apnr.2019.151192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6904515PMC
December 2019

The Contribution of Living Arrangements, Social Support, and Self-efficacy to Self-management Behaviors Among Individuals With Heart Failure: A Path Analysis.

J Cardiovasc Nurs 2019 Jul/Aug;34(4):319-326

Elliane Irani, PhD, RN Postdoctoral Fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Scott Emory Moore, PhD, APRN, AGPCNP-BC Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Ronald L. Hickman, PhD, RN, ACNP-BC, FNAP, FAAN Associate Professor and Associate Dean for Research, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Mary A. Dolansky, PhD, RN, FAAN Associate Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Richard A. Josephson, MS, MD Professor, School of Medicine, Case Western Reserve University; and Director of Cardiovascular and Pulmonary Rehabilitation, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio. Joel W. Hughes, PhD Professor, Department of Psychological Sciences, Kent State University, Ohio.

Background: Living arrangements, social support, and self-efficacy have significant implications for self-management science. Despite the theoretical linkages among the 3 concepts, there is limited empirical evidence about their interplay and the subsequent influence on heart failure (HF) self-management.

Objective: The aim of this study was to validate components of the Individual and Family Self-management Theory among individuals with HF.

Methods: This is a secondary analysis of cross-sectional data generated from a sample of 370 individuals with HF. A path analysis was conducted to examine the indirect and direct associations among social environment (living arrangements), social facilitation (social support) and belief (self-efficacy) processes, and self-management behaviors (HF self-care maintenance) while accounting for individual and condition-specific factors (age, sex, race, and HF disease severity).

Results: Three contextual factors (living arrangements, age, and HF disease severity) had direct associations with perceived social support and self-efficacy, which in turn were positively associated with HF self-management behaviors. Living alone (β = -.164, P = .001) was associated with lower perceived social support, whereas being an older person (β = .145, P = .004) was associated with better support. Moderate to severe HF status (β = -.145, P = .004) or higher levels of perceived social support (β = .153, P = .003) were associated with self-efficacy.

Conclusions: Our results support the Individual and Family Self-management Theory, highlighting the importance of social support and self-efficacy to foster self-management behaviors for individuals with HF. Future research is needed to further explore relationships among living arrangements, perceived and received social support, self-efficacy, and HF self-management.
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http://dx.doi.org/10.1097/JCN.0000000000000581DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557687PMC
October 2020

Nursing Theory and Research: The Path Forward.

Authors:
Ronald L Hickman

ANS Adv Nurs Sci 2019 Jan/Mar;42(1):85-86

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

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http://dx.doi.org/10.1097/ANS.0000000000000255DOI Listing
May 2020

Correlates of Cognitive Load in Surrogate Decision Makers of the Critically III.

West J Nurs Res 2019 05 26;41(5):650-666. Epub 2018 Oct 26.

1 Case Western Reserve University, Cleveland, OH, USA.

Surrogate decision makers (SDMs) of the critically ill experience intense emotions and transient states of decision fatigue. These factors may increase the cognitive load experienced by electronic decision aids. This cross-sectional study explored the associations of emotion regulation (expressive suppression and cognitive reappraisal) and decision fatigue with cognitive load (intrinsic and extraneous) among a sample of 97 SDMs of the critically ill. After completing subjective measures of emotion regulation and decision fatigue, participants were exposed to an electronic decision aid and completed a subjective measurement of cognitive load. Multiple regression analyses indicated that decision fatigue predicted intrinsic cognitive load and expressive suppression predicted extraneous cognitive load. Emotion regulation and decision fatigue represent modifiable determinants of cognitive load among SDMs exposed to electronic decision aids.
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http://dx.doi.org/10.1177/0193945918807898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467818PMC
May 2019

A preliminary psychometric evaluation of the eight-item cognitive load scale.

Appl Nurs Res 2018 04 31;40:99-105. Epub 2018 Jan 31.

Case Western Reserve University, Cleveland, OH, United States.

Aim: The aim of this article is to report the psychometric properties of the eight-item cognitive load scale.

Background: According to cognitive load theory, the formatting and delivery of healthcare education influences the degree to which patients and/or family members can engage their working memory systems for learning. However, despite its relevance, cognitive load has not yet been evaluated among surrogate decision makers exposed to electronic decision support for healthcare decisions. To date, no psychometric analyses of instruments evaluating cognitive load have been reported within healthcare settings.

Methods: A convenience sample of 62 surrogate decision makers for critically ill patients were exposed to one of two healthcare decision support interventions were recruited from four intensive care units at a tertiary medical center in Northeast Ohio. Participants were administered a battery of psychosocial instruments and the eight-item cognitive load scale (CLS).

Results: The CLS demonstrated a bidimensional factor structure with acceptable discriminant validity and internal consistency reliability (Cronbach's α = 0.75 and 0.89).

Conclusions: The CLS is a psychometrically sound instrument that may be used in the evaluation of decision support among surrogate decision makers of the critically ill. The authors recommend application of the cognitive load scale in the evaluation and development of healthcare education and interventions.
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http://dx.doi.org/10.1016/j.apnr.2018.01.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5873589PMC
April 2018

Decision fatigue: A conceptual analysis.

J Health Psychol 2020 01 23;25(1):123-135. Epub 2018 Mar 23.

Case Western Reserve University, USA.

Decision fatigue is an applicable concept to healthcare psychology. Due to a lack of conceptual clarity, we present a concept analysis of decision fatigue. A search of the term "decision fatigue" was conducted across seven research databases, which yielded 17 relevant articles. The authors identified three antecedent themes (decisional, self-regulatory, and situational) and three attributional themes (behavioral, cognitive, and physiological) of decision fatigue. However, the extant literature failed to adequately describe consequences of decision fatigue. This concept analysis provides needed conceptual clarity for decision fatigue, a concept possessing relevance to nursing and allied health sciences.
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http://dx.doi.org/10.1177/1359105318763510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119549PMC
January 2020

Predictors of Moral Distress in a US Sample of Critical Care Nurses.

Am J Crit Care 2018 01;27(1):59-66

Catherine A. Hiler is an assistant professor, Ronald L. Hickman, Jr, is an associate professor, Andrew P. Reimer and Kimberly Wilson are assistant professors, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.

Background: Moral distress in registered nurses causes decreased job satisfaction, turnover in staffing, burnout, and heightened states of psychological distress. To date, investigation of modifiable factors, such as perceptions of the practice environment and patient safety, among a diverse sample of critical care nurses has been limited.

Objective: To explore the relationships among the severity of moral distress, the practice environment, and patient safety in a national sample of critical care nurses.

Methods: Critical care nurses experienced in working with adults (> 1 year of intensive care unit experience) and who were subscribers to the American Association of Critical-Care Nurses' e-mail listserv and social media sites anonymously participated in this descriptive study. Participants completed a demographic questionnaire, the Moral Distress Scale-Revised, and the Practice Environment Scale of the Nursing Work Index. Descriptive statistics, bivariate correlation coefficients, and a hierarchical regression analysis were used to describe the sample characteristics and to assess relationships among the study variables.

Results: Of a national sample of 328 critical care nurses, 56% had less than 20 years of experience as a registered nurse. Moral distress was modestly associated with negative perceptions of the practice environment and patient safety. Job satisfaction, practice environment, and the participant's age were statistically significant predictors of moral distress in this sample.

Conclusions: Modifications of organizational factors such as the development of healthy work environments that promote collegial relationships could reduce moral distress among critical care nurses.
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http://dx.doi.org/10.4037/ajcc2018968DOI Listing
January 2018

Evaluation of the Decisional Fatigue Scale Among Surrogate Decision Makers of the Critically Ill.

West J Nurs Res 2018 02 14;40(2):191-208. Epub 2017 Aug 14.

1 Case Western Reserve University, Cleveland, OH, USA.

Intense emotional distress and impaired information processing have been implicated in reducing a surrogate decision maker's ability to formulate informed health care decisions for a critically ill patient. The heightened intensity of negative emotions, mental effort, and impaired judgment is consistent with the manifestation of decision fatigue. The aim of this article is to describe the validity and reliability of the Decision Fatigue Scale (DFS) among surrogate decision makers of the critically ill. A convenience sample of 101 surrogate decision makers were administered the DFS and a battery of psychosocial instruments at two time points. The DFS was specified as a unidimensional measure with adequate internal consistency (Cronbach's αs = .87, .90) and stability reliability. Discriminant validity was established with measures of emotion regulation, anxiety, and depressive symptoms. The DFS is the first subjective measure of decision fatigue for surrogate decision makers of the critically ill that demonstrates satisfactory psychometric properties.
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http://dx.doi.org/10.1177/0193945917723828DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750078PMC
February 2018

Evidence-Based Review and Discussion Points.

Authors:
Ronald L Hickman

Am J Crit Care 2017 07;26(4):342-343

Ronald L. Hickman is an associate professor, Case Western Reserve University, and an acute care nurse practitioner at University Hospitals Case Medical Center, Cleveland, Ohio.

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http://dx.doi.org/10.4037/ajcc2017640DOI Listing
July 2017

Response of Flight Nurses in a Simulated Helicopter Environment.

Air Med J 2017 May - Jun;36(3):131-134. Epub 2017 Mar 31.

Student of Doctor of Nursing Practice, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.

Objective: The purpose of this study was to determine if a helicopter flight simulator could provide a useful educational platform by creating experiences similar to those encountered by actual flight nurses.

Methods: Flight nurse (FN) and non-FN participants completed a simulated emergency scenario in a flight simulator. Physiologic and psychological stress during the simulation was measured using heart rate and perceived stress scores. A questionnaire was then administered to assess the realism of the flight simulator.

Results: Subjects reported that the overall experience in the flight simulator was comparable with a real helicopter. Sounds, communications, vibrations, and movements in the simulator most approximated those of a real-life helicopter environment. Perceived stress levels of all participants increased significantly from 27 (on a 0-100 scale) before simulation to 51 at the peak of the simulation and declined thereafter to 28 (P < .001). Perceived stress levels of FNs increased significantly from 25 before simulation to 54 at the peak of the simulation and declined thereafter to 30 (P < .001). Perceived stress levels of non-FNs increased significantly from 31 before simulation to 49 at the peak of the simulation and declined thereafter to 25 (P < .001). There were no significant differences in perceived stress levels between FNs and non-FNs before (P = .58), during (P = .63), or after (P = .55) simulation. FNs' heart rates increased significantly from 77 before simulation to 100 at the peak of the simulation and declined thereafter to 72 (P < .001).

Conclusion: The results of this study suggest that simulation of a critical care scenario in a high-fidelity helicopter flight simulator can provide a realistic helicopter transport experience and create physiologic and psychological stress for participants.
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http://dx.doi.org/10.1016/j.amj.2017.02.005DOI Listing
May 2018

Evidence-Based Review and Discussion Points.

Authors:
Ronald L Hickman

Am J Crit Care 2017 05;26(3):255-256

Ronald L. Hickman is an associate professor, Case Western Reserve University, and an acute care nurse practitioner at University Hospitals Case Medical Center, Cleveland, Ohio.

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http://dx.doi.org/10.4037/ajcc2017286DOI Listing
May 2017

Construct Validity and Reliability of the Questionnaire on the Quality of Physician-Patient Interaction in Adults With Hypertension.

J Nurs Meas 2017 04;25(1):17-30

Background And Purpose: There are limited reliable and valid measures of the patient- provider interaction among adults with hypertension. Therefore, the purpose of this report is to describe the construct validity and reliability of the Questionnaire on the Quality of Physician-Patient Interaction (QQPPI), in community-dwelling adults with hypertension.

Methods: A convenience sample of 109 participants with hypertension was recruited and administered the QQPPI at baseline and 8 weeks later.

Results: The exploratory factor analysis established a 12-item, 2-factor structure for the QQPPI was valid in this sample. The modified QQPPI proved to have sufficient internal consistency and test- retest reliability.

Conclusions: The modified QQPPI is a valid and reliable measure of the provider-patient interaction, a construct posited to impact self-management, in adults with hypertension.
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http://dx.doi.org/10.1891/1061-3749.25.1.E17DOI Listing
April 2017

Stress and Coping of Critical Care Nurses After Unsuccessful Cardiopulmonary Resuscitation.

Am J Crit Care 2017 Mar;26(2):128-135

Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University.

Background: Participation by a critical care nurse in an unsuccessful resuscitation can create a unique heightened level of psychological stress referred to as postcode stress, activation of coping behaviors, and symptoms of posttraumatic stress disorder (PTSD).

Objectives: To explore the relationships among postcode stress, coping behaviors, and PTSD symptom severity in critical care nurses after experiencing unsuccessful cardiopulmonary resuscitations and to see whether institutional support attenuates these repeated psychological traumas.

Methods: A national sample of 490 critical care nurses was recruited from the American Association of Critical-Care Nurses' eNewsline and social media. Participants completed the Post-Code Stress Scale, the Brief COPE (abbreviated), and the Impact of Event Scale-Revised, which were administered through an online survey.

Results: Postcode stress and PTSD symptom severity were weakly associated ( = 0.20, = .01). No significant associations between coping behaviors and postcode stress were found. Four coping behaviors (denial, self-distraction, self-blame, and behavioral disengagement) were significant predictors of PTSD symptom severity. Severity of postcode stress and PTSD symptoms varied with the availability of institutional support.

Conclusions: Critical care nurses show moderate levels of postcode stress and PTSD symptoms when asked to recall an unsuccessful resuscitation and the coping behaviors used. Identifying the critical care nurses most at risk for PTSD will inform the development of interventional research to promote critical care nurses' psychological well-being and reduce their attrition from the profession.
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http://dx.doi.org/10.4037/ajcc2017916DOI Listing
March 2017

Evidence-Based Review and Discussion Points.

Authors:
Ronald L Hickman

Am J Crit Care 2017 03;26(2):126-127

Ronald L. Hickman is an associate professor, Case Western Reserve University, and an acute care nurse practitioner at University Hospitals Case Medical Center, Cleveland, Ohio.

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http://dx.doi.org/10.4037/ajcc2017698DOI Listing
March 2017

Evidence-Based Review and Discussion Points.

Authors:
Ronald L Hickman

Am J Crit Care 2016 12;26(1):28-29

Ronald L. Hickman is an associate professor, Case Western Reserve University, and an acute care nurse practitioner at University Hospitals Case Medical Center, Cleveland, Ohio.

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http://dx.doi.org/10.4037/ajcc2017126DOI Listing
December 2016

Evidence-Based Review and Discussion Points.

Authors:
Ronald L Hickman

Am J Crit Care 2016 07;25(4):362-3

Ronald L. Hickman is an associate professor, Case Western Reserve University, and an acute care nurse practitioner at University Hospitals Case Medical Center, Cleveland, Ohio.

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http://dx.doi.org/10.4037/ajcc2016431DOI Listing
July 2016

Evidence-Based Review and Discussion Points.

Authors:
Ronald L Hickman

Am J Crit Care 2016 Mar;25(2):126-7

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http://dx.doi.org/10.4037/ajcc2016296DOI Listing
March 2016

Evidence-Based Review and Discussion Points.

Authors:
Ronald L Hickman

Am J Crit Care 2016 05;25(3):220-1

Ronald L. Hickman is an associate professor, Case Western Reserve University, and an acute care nurse practitioner at University Hospitals Case Medical Center, Cleveland, Ohio.

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http://dx.doi.org/10.4037/ajcc2016154DOI Listing
May 2016

Evidence-Based Review and Discussion Points.

Authors:
Ronald L Hickman

Am J Crit Care 2016 Jan;25(1):59-60

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http://dx.doi.org/10.4037/ajcc2016964DOI Listing
January 2016
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