Publications by authors named "Stephanie Griggs"

20 Publications

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Building Therapeutic Commitment in University Nursing Students.

Nurse Educ 2021 Jul 19. Epub 2021 Jul 19.

Author Affiliations: Clinical Associate Professor (Dr Dion) and Associate Professor (Dr Choi), University of Massachusetts Amherst College of Nursing; and Instructor (Dr Griggs), Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.

Background: Nurses report feeling unprepared to care for people with a substance use disorder (SUD).

Purpose: The purpose was to determine whether targeted antistigma interventions improved nursing students' attitudes and perceived stigma toward people with SUD.

Methods: This was a quasi-experimental, repeated-measures survey study. Participants completed the 20-item Drug and Drug Problems Questionnaire (DDPPQ) and the 8-item Perceived Stigma of Substance Abuse Scale (PSAS) at baseline and postintervention in their first clinical semester. Booster sessions were held for 2 additional clinical semesters after the initial intervention in the first clinical semester. The DDPPQ and PSAS were completed at the end of each semester for 3 semesters of the nursing program.

Results: After the educational interventions, there was a significant improvement in overall therapeutic attitudes except for 1 subscale, role-related self-esteem.

Conclusions: Antistigma interventions led to a decrease in stigma and improved overall therapeutic attitudes toward people with SUD.
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http://dx.doi.org/10.1097/NNE.0000000000001060DOI Listing
July 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

Evaluation of Web-Based and In-Person Methods to Recruit Adults With Type 1 Diabetes for a Mobile Exercise Intervention: Prospective Observational Study.

JMIR Diabetes 2021 Jul 8;6(3):e28309. Epub 2021 Jul 8.

Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.

Background: Our clinical trial of a mobile exercise intervention for adults 18 to 65 years old with type 1 diabetes (T1D) occurred during COVID-19 social distancing restrictions, prompting us to test web-based recruitment methods previously underexplored for this demographic.

Objective: Our objectives for this study were to (1) evaluate the effectiveness and cost of using social media news feed advertisements, a clinic-based approach method, and web-based snowball sampling to reach inadequately active adults with T1D and (2) compare characteristics of enrollees against normative data.

Methods: Participants were recruited between November 2019 and August 2020. In method #1, Facebook and Instagram news feed advertisements ran for five 1-to-8-day windows targeting adults (18 to 64 years old) in the greater New Haven and Hartford, Connecticut, areas with one or more diabetes-related profile interest. If interested, participants completed a webform so that the research team could contact them for eligibility screening. In method #2, patients 18 to 24 years old with T1D were approached in person at clinical visits in November and December 2019. Those who were interested immediately completed eligibility screening. Older patients could not be approached due to clinic restrictions. In method #3, snowball sampling was conducted by physically active individuals with T1D contacting their peers on Facebook and via email for 48 days, with details to contact the research staff to express interest and complete eligibility screening. Other methods referred participants to the study similarly to snowball sampling.

Results: In method #1, advertisements were displayed to 11,738 unique viewers and attracted 274 clickers (2.33%); 20 participants from this group (7.3%) volunteered, of whom 8 (40%) were eligible. Costs averaged US $1.20 per click and US $95.88 per eligible volunteer. Men had lower click rates than women (1.71% vs 3.17%; P<.001), but their responsiveness and eligibility rates did not differ. In method #2, we approached 40 patients; 32 of these patients (80%) inquired about the study, of whom 20 (63%) volunteered, and 2 of these volunteers (10%) were eligible. Costs including personnel for in-person approaches averaged US $21.01 per inquirer and US $479.79 per eligible volunteer. In method #3, snowball sampling generated 13 inquirers; 12 of these inquirers (92%) volunteered, of whom 8 (67%) were eligible. Incremental costs to attract inquirers were negligible, and total costs averaged US $20.59 per eligible volunteer. Other methods yielded 7 inquirers; 5 of these inquirers (71%) volunteered, of whom 2 (40%) were eligible. Incremental costs to attract inquirers were negligible, and total costs averaged US $34.94 per eligible volunteer. Demographic overrepresentations emerged in the overall cohort (ie, optimal glycemic control, obesity, and low exercise), among those recruited by news feed advertisements (ie, obesity and older age), and among those recruited by snowball sampling (ie, optimal glycemic control and low exercise).

Conclusions: Web-based advertising and recruitment strategies are a promising means to attract adults with T1D to clinical trials and exercise interventions, with costs comparing favorably to prior trials despite targeting an uncommon condition (ie, T1D) and commitment to an intervention. These strategies should be tailored in future studies to increase access to higher-risk participants.

Trial Registration: ClinicalTrials.gov NCT04204733; https://clinicaltrials.gov/ct2/show/NCT04204733.
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http://dx.doi.org/10.2196/28309DOI Listing
July 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

Ecological momentary assessment for health behaviors and contextual factors in persons with diabetes: A systematic review.

Diabetes Res Clin Pract 2021 Apr 10;174:108745. Epub 2021 Mar 10.

Yale University, School of Nursing, 400 West Campus Dr. Orange, Connecticut 06477, United States.

Aim: The objective of this systematic review was to summarize the ecological momentary assessment (EMA) methodology and associations between EMA-measured psychosocial, contextual factors and diabetes self-management.

Methods: The inclusion criteria were: research of EMA and diabetes self-management behaviors such as glucose checks, administration of insulin and eating-and dietary intake behaviors among persons with diabetes. A comprehensive search of several databases was conducted across all dates until July 2020.

Results: A modified Checklist for Reporting EMA Studies was used to assess the quality of studies. Among the ten included studies, participants were predominantly White adolescents with type 1 diabetes (T1D) and type 2 diabetes was studied in two studies. Time-varying, psychosocial contexts such as negative affect or negative social interaction were associated with missed insulin injection and poor adherence to glucose check. More preceding psychological stress was associated with more calorie intake from snacks or binge eating behaviors. Mornings were the most challenging time of day for adherence to diabetes self-management among adolescents with T1D. Intentional insulin withholding was more common in the afternoon in adults with T1D.

Conclusions: EMA has potential clinical utility in the assessment of diabetes self-management and in the development of timely and individualized diabetes interventions.
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http://dx.doi.org/10.1016/j.diabres.2021.108745DOI Listing
April 2021

Daily variations in sleep and glucose in adolescents with type 1 diabetes.

Pediatr Diabetes 2020 12 28;21(8):1493-1501. Epub 2020 Sep 28.

Annie Goodrich Professor of Nursing and Professor of Pediatrics, Yale University, School of Nursing and School of Medicine, West Haven, Connecticut, 06477, USA.

Objective: We used multilevel models (MLMs) to determine person (between-persons) and day level (within-person) associations between glucose variability indices and sleep characteristics in adolescents with type 1 diabetes (T1D).

Methods: Adolescents with T1D (Mean age 13.4 ± 1.8 years; 37.8% male; mean HbA1c 8.2 ± 1.2%, 66 mmol/mol) monitored their sleep and glucose patterns concurrently for 3-7 days with a wrist actigraph on their non-dominant wrist and a continuous glucose monitor (CGM) (their own or a provided, blinded CGM). Glucose variability indices included J index, coefficient of variation, low and high blood glucose risk indices (LBGI and HBGI), time in range, and sleep characteristics, including bedtime, wake time, total sleep time, sleep efficiency, wake after sleep onset, awakenings, and sleep fragmentation index.

Results: More overall glucose variability was associated within person, more sleep disruptions (more awakenings and more fragmentation) or poorer sleep in our study (earlier wake time or longer wake after sleep onset). Also, more time spent in hypoglycemia <70 mg/dL and a higher LBGI was associated within person with earlier wake time indicating poorer sleep. However, a lower LBGI was associated with a later between-persons wake time.

Conclusions: Monitoring over a longer period of time in subsequent studies would allow researchers to determine the within person association between habitual short sleep duration and glucose variability. Providers should regularly assess sleep habits in adolescents as a way to improve glycemic control. Targeting a euglycemic range overnight is also important to promote better sleep and to decrease sleep disruptions.
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http://dx.doi.org/10.1111/pedi.13117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642150PMC
December 2020

A systematic review and meta-analysis of behavioral sleep interventions for adolescents and emerging adults.

Sleep Med Rev 2020 12 8;54:101356. Epub 2020 Jul 8.

Yale School of Nursing, West Haven, Connecticut 06477, USA; Yale University, School of Nursing and School of Medicine, West Haven, CT 06477, USA. Electronic address:

In the United States, more than two-thirds of adolescents and one-third of emerging adults report habitual short sleep duration, which is a known risk factor for psychological distress. The primary aim of this systematic review and meta-analysis was to evaluate the effect of behavioral sleep-promoting interventions on the sleep characteristics (e.g., total sleep time and sleep efficiency) of adolescents and emerging adults (aged 12-25 y) who do not have a sleep disorder. The secondary aim was to determine the effect of behavioral sleep-promoting interventions on psychological distress. Multiple electronic databases were searched for relevant randomized controlled trials (RCTs) published in English. Fourteen RCTs were included in the qualitative synthesis (N = 932), seven were included in the meta-analysis (n = 711) to address the primary aim, and three (n = 253) were included to address the secondary aim. The pooled standardized mean difference for sleep-promoting interventions after treatment for total sleep time was 34.92 min (95% CI: 8.70, 61.14). Sleep-promoting interventions had no significant effect on sleep efficiency. More RCTs that involve adolescents and emerging adults are needed to determine the effect of sleep-promoting interventions on reducing psychological distress in this high-risk age group.
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http://dx.doi.org/10.1016/j.smrv.2020.101356DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669566PMC
December 2020

Sleep, self-management, neurocognitive function, and glycemia in emerging adults with Type 1 diabetes mellitus: A research protocol.

Res Nurs Health 2020 08 8;43(4):317-328. Epub 2020 Jul 8.

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

Type 1 Diabetes (T1D) affects 1.6 million Americans, and only 14% of emerging adults ages 18-25 years achieve targets for glycemic control (A1C < 7.0%). Sleep deficiency, including habitual short sleep duration (<6.5 hr total sleep time and high within-person variability in total sleep time), is associated with poorer glycemic control. Emerging adults with T1D have a more pronounced sleep extension on weekends compared with matched controls, consistent with sleep deficiency; however, associations among sleep variability and glycemic control have not been explored in this population. Sleep deficiency may affect the complex higher-order neurocognitive functioning needed for successful diabetes self-management (DSM). We report the protocol for an ongoing study designed to characterize sleep and the associations among sleep deficiency, neurocognitive function, DSM, diabetes quality of life, and glycemia among a sample of 40 emerging adults with T1D. We monitor sleep via wrist-worn actigraphy and glucose via continuous glucose monitoring concurrently over 14 days. We are collecting data on self-report and objective sleep, a 10-min psychomotor vigilance test on a PVT-192 device, a 3-min Trail Making Test on paper, and questionnaires, including twice-daily Pittsburgh sleep diaries using Research Electronic Data Capture (REDCap) . Results from this study will be used to support the development and testing of the efficacy of a tailored sleep self-management intervention that may improve total sleep time, sleep variability, neurocognitive function, DSM, glycemic control, and glucose variability among emerging adults with T1D.
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http://dx.doi.org/10.1002/nur.22051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382362PMC
August 2020

Facilitators and Barriers of Sleep in Young Adults With Type 1 Diabetes.

Diabetes Educ 2020 06 8;46(3):242-251. Epub 2020 May 8.

Yale University.

Purpose: The purpose of this study was to explore the perceived facilitators and barriers for obtaining sufficient sleep in young adults with type 1 diabetes (T1D).

Methods: A qualitative descriptive approach was used to generate data. In-depth semi-structured interviews with 30 young adults with T1D (66.7% female, mean age = 22.1 years) were conducted. Interviews were transcribed verbatim and coded using NVivo.

Results: Young adults with T1D reported feeling challenged at bedtime and overnight by the demands of a complex disease management regimen. General and diabetes-specific barriers and facilitators to obtaining sufficient sleep were the overarching themes in the present study. Young adults perceived that electronic device use was a facilitator for relaxation before bed and a barrier to sleep by some participants. Delays in bedtime or disruptions in sleep were common diabetes-specific barriers.

Conclusions: When designing sleep-promoting interventions for young adults with T1D, researchers should consider diabetes-specific challenges and solutions in addition to those present in the general young adult population.
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http://dx.doi.org/10.1177/0145721720916179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329586PMC
June 2020

Sleep and Glycemia in Youth With Type 1 Diabetes.

J Pediatr Health Care 2020 Jul - Aug;34(4):315-324. Epub 2020 Mar 11.

Introduction: Short sleep duration and quality are problems for many youth, and are associated with difficulties in executive function. Our purpose was to describe subjective and objective sleep characteristics and their associations with executive function, stress and coping, adjustment, and self-management in youth with type 1 diabetes (T1D).

Method: Youth with T1D (N = 40; mean age, 13.4 ± 1.9 years; 60% female; 77.1% non-Hispanic white; diabetes duration, 7.1 ± 4.6 years; and hemoglobin A1c, 8.2 ± 1.2%) wore an actigraph and a continuous glucose monitor for 3-7 days and completed questionnaires. Descriptive and bivariate analyses were conducted.

Results: Sleep variability was associated with stress and depressive symptoms, as well as more glucose variability. Consistent rest-activity rhythm timing was associated with fewer trait anxiety symptoms. Robust rhythms were associated with better diabetes self-management.

Discussion: Providers should routinely assess sleep habits in youth, especially those with T1D. Improving consistency in sleep timing and sleep duration may be a potential therapeutic target to improve diabetes clinical outcomes.
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http://dx.doi.org/10.1016/j.pedhc.2019.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311270PMC
March 2020

End-of-Life Nursing Knowledge Among Nursing Students.

J Nurs Educ 2020 Mar;59(3):154-157

Background: The U.S. health care system is poorly designed to meet the needs of patients at the end of life (EOL) and their families. Nursing students often have reported feeling inadequate to provide EOL care.

Method: Following an EOL simulation, reflective journals were collected from junior and senior nursing students and analyzed for themes using qualitative content analysis. The condensed meaning units were abstracted into codes based on Carper's fundamental patterns of knowing.

Results: Thirty-one junior and senior nursing students (mean age, 21.04 ± 0.52 years, 96.2% female) in a baccalaureate program participated in the study. The broad themes of student reflections included empirics (theoretical or natural historical) aesthetics (transformative nursing action), personal (interpersonal process of nurse-patient interaction), and ethics (emotion influences actions).

Conclusion: Student perception and participation in all roles contributes to the gestalt of the experience of a highly emotional EOL simulation for both students and faculty. [J Nurs Educ. 2020;59(3):154-157.].
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http://dx.doi.org/10.3928/01484834-20200220-06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156273PMC
March 2020

Teaching Those Who Care How to Care for a Person With Substance Use Disorder.

Nurse Educ 2020 Nov/Dec;45(6):321-325

Background: Substance use disorder (SUD) is on the rise globally, and nurses are not prepared to care for this population.

Purpose: The purpose was to determine if a 4-hour antistigma intervention improved prelicensure student nurse attitudes and perceived stigma toward people with SUD.

Methods: This was a nonrandomized quasi-experimental survey study. Participants completed the 20-item Drug and Drug Problems Perception Questionnaire (DDPPQ), the 8-item Perceived Stigma of Substance Abuse Scale (PSAS), and the 13-item Marlowe-Crowne Social Desirability Scale at baseline and repeated the DDPPQ and PSAS postintervention. Paired t tests were used to determine the mean differences in the total DDPPQ and total PSAS scores.

Results: After the antistigma intervention, there was a significant improvement in overall therapeutic attitudes (t = 8.4, df = 108, P < .001) and perceived stigma (t = -2.5, df = 108, P = .01) in undergraduate nursing students (n = 126).

Conclusions: Incorporating antistigma educational approaches may lead to more involvement and compassionate care for people with SUD.
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http://dx.doi.org/10.1097/NNE.0000000000000808DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7438244PMC
June 2021

Differences in hope, core self-evaluations, emotional well-being, and health risk behaviors in freshman university students.

Nurs Forum 2019 Oct 16;54(4):505-512. Epub 2019 Jul 16.

Division of Preventive and Behavioral Medicine, Department of Medicine, Graduate School of Nursing, University of Massachusetts Medical School, Worcester, Massachusetts.

The purpose of this cross-sectional anonymous survey study was to explore differences in hope, core self-evaluations (CSE), emotional well-being, health risk behaviors, and academic performance by gender, race, and social desirability in a sample of freshman university students. Four hundred and ninety-five freshmen ages 18 to 21 (M age 18.4), 67% female attending a large public university in the Northeast participated in the study. A Health Risk Behavior Score, with scores ranging from 3 to 9, was calculated by creating risk categories for drug use, alcohol use, and sexual risk-taking. Hope and health risk behaviors did not differ by gender, however, men reported higher CSE and emotional well-being. There were racial differences in hope, CSE, emotional well-being, and health risk behaviors. Nurses and researchers should consider gender and racial differences when designing or implementing hope interventions. Future researchers should compare their findings with ours for patterns or convergence and divergence and aim for larger representative samples of nonwhite groups. These are necessary next steps to advance the understanding of the role hope may play in promoting mental health among diverse college students.
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http://dx.doi.org/10.1111/nuf.12364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6856360PMC
October 2019

Violence exposure, conflict, and health outcomes in inner-city African American adolescents.

Nurs Forum 2019 Oct 16;54(4):513-525. Epub 2019 Jul 16.

College of Nursing, University of Massachusetts-Amherst, Amherst, Massachusetts.

Purpose: To examine relationships among community and school violence exposure, parent-adolescent conflict, coping style, and self-reported health in a sample of 432 high-risk, inner-city African American adolescents at age 14 years.

Design And Methods: Multiple regression and principal component analysis were used to analyze the secondary data. After controlling for multiple covariates (eg, sex, age, blood lead levels, and socioeconomic status), both violence exposure and posttraumatic stress symptoms (PTSS) were related to health outcomes. The survey of exposure to community violence, the safe-school survey, and the conflict tactics scale were used to measure community violence, school violence, and parent-adolescent conflict. Coping was evaluated using the general coping scale. The child health illness profile-adolescent edition was used to obtain self-reported health measures, and the clinician-assisted PTSD scale was used to measure PTSS.

Results: Higher exposure to community violence was associated with less emotional comfort, less family involvement, higher individual risk, and poorer academic and work performance. Parent-adolescent conflict predicted less physical and emotional comfort and poorer home safety and health.

Conclusions: Our findings suggest that it is important to evaluate both violence exposure and the responses to the exposure, which can include both PTSS and diverse coping strategies.
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http://dx.doi.org/10.1111/nuf.12365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6856364PMC
October 2019

Nursing student perceptions of hope in children: A qualitative descriptive study.

Nurs Forum 2019 Jul 29;54(3):441-447. Epub 2019 May 29.

University of Massachusetts, College of Nursing, Amherst, Massachusetts.

Hope has been linked to positive health outcomes in the literature. Hope is abstract, multidimensional, future oriented, and occurs cognitively making it difficult to assess in children. Most of the research on hope has been conducted with adults and adolescents. Therefore, it is essential to analyze the concept of hope in children to provide nurses with tools to identify hope behaviors in children. The aim of this qualitative descriptive study was to describe hope behaviors in children from a nursing student perspective. Data were gathered from three focus groups (N = 19) of nursing students enrolled in a pediatric clinical rotation using a semistructured interview technique. Three themes of hope behaviors emerged from the three focus groups and were (a) future oriented, (b) goal oriented-getting up and doing things, and (c) pathways thinking processes-getting from point A to point B. Health care providers should consider hope behavioral cues, which can warrant interventions to increase hope in their young patients. Current findings demonstrate the need for the development of hope interventions that involve younger patients, thereby making their effects more sustainable across the lifespan.
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http://dx.doi.org/10.1111/nuf.12352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6693973PMC
July 2019

Sleep characteristics in young adults with type 1 diabetes.

Diabetes Res Clin Pract 2019 Apr 18;150:17-26. Epub 2019 Feb 18.

Yale University, School of Nursing, United States.

Only 14% of young adults with Type 1 Diabetes (T1D) achieve targets for glycemic control (HbA1C < 7.0%), with deterioration over time. Complex cognitive processes required to manage glycemia are vulnerable to sleep deficiency. Using Whittemore and Knafl's approach, we conducted an integrative review of research literature on sleep characteristics and glycemia in these young adults. Quality was assessed using the Mixed Methods Appraisal Tool (v. 2011). Multiple databases were searched for articles published in English in peer-reviewed journals from 2003 to 2018, using search terms 'sleep' and 'T1D' with age limiters 18-40. Of 218 studies initially retrieved, 17 original studies met the inclusion criteria. The following themes were identified in young adults with T1D: (1) They had poorer objective and subjective sleep quality, more variability, and impaired awakening response to hypoglycemia compared with controls; (2) They had poorer glycemic control that was associated with shorter sleep duration, poorer sleep quality, and less time in deep sleep; and (3) Hypoglycemia negatively impacted diabetes management, sleep quality, and next day functioning. Sleep deficiency, as indicated by short sleep duration is associated with a range of negative health outcomes for people with T1D; therefore, optimizing sleep should be a priority in practice and research.
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http://dx.doi.org/10.1016/j.diabres.2019.02.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525057PMC
April 2019

Fatigue Among Adults With Type 1 Diabetes Mellitus and Implications for Self-Management: An Integrative Review.

Diabetes Educ 2018 08 26;44(4):325-339. Epub 2018 Jun 26.

University of Massachusetts Medical School, Worcester, Massachusetts.

Purpose The aim of this review was to integrate empirical and theoretical literature on fatigue among adults with type 1 diabetes mellitus (T1DM). A methodological review using an integrative approach was used. Databases MEDLINE via Pubmed, CINAHL, PsycINFO, and Science Direct were searched for peer-reviewed articles published in English from 2007-2017, using the following search terms and Boolean operators: "Type 1 Diabetes" and "Fatigue." Of 199 articles initially retrieved, 14 were chosen for inclusion. These articles included 13 quantitative (7 cross-sectional, 2 cohort, 2 secondary data analyses, 2 experimental) and 1 qualitative phenomenology. Fatigue was identified as one of the most troublesome symptoms reported in persons with T1DM. Four main themes emerged: fatigue in T1DM is multidimensional and related to psychological, physiological, situational, and sociodemographic factors. Conclusions Fatigue is considered a classic symptom of hyperglycemia; however, there were minimal data to support the theory that fatigue is related to hyperglycemia or hypoglycemia. Studies on fatigue among persons with T1DM are limited to small samples and cross-sectional designs with few randomized controlled trials addressing fatigue and diabetes-related symptoms. Evidence is conflicting regarding the onset of fatigue among persons with T1DM and the relationship between fatigue and diabetes duration. The prevalence of fatigue is likely influenced by disease physiology, psychological stress, and lifestyle factors, but more research is needed to confirm these relationships as causal inference is unclear.
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http://dx.doi.org/10.1177/0145721718782148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372920PMC
August 2018

Hope, Core Self-Evaluations, Emotional Well-Being, Health-Risk Behaviors, and Academic Performance in University Freshmen.

J Psychosoc Nurs Ment Health Serv 2017 Sep;55(9):33-42

The purpose of the current online cross-sectional study was to examine the relationship between hope, core self-evaluations (CSE), emotional well-being, health-risk behaviors, and academic performance in students enrolled in their first year of college. Freshmen (N = 495) attending a large public university in the Northeastern United States completed an online survey between February 1 and 13, 2017. Linear regression, path analysis, and structural equation modeling procedures were performed. CSE mediated the relationship between hope and emotional well-being and academic performance. Contrary to the hypotheses, higher hope predicted more sexual risk-taking behaviors and alcohol use. CSE is an important component of Hope Theory, which is useful for predicting emotional well-being and academic performance, but not as useful for predicting drug use, alcohol use, and sexual risk taking. Hope and CSE interventions are needed to improve academic performance and emotional well-being in university freshmen. [Journal of Psychosocial Nursing and Mental Health Services, 55(9), 33-42.].
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http://dx.doi.org/10.3928/02793695-20170818-11DOI Listing
September 2017

Hope and Mental Health in Young Adult College Students: An Integrative Review.

Authors:
Stephanie Griggs

J Psychosoc Nurs Ment Health Serv 2017 Feb;55(2):28-35

One in five young adults are diagnosed with a mental illness and many experience psychological distress during their first year of college due to new pressures in academia. The purpose of the current integrative review was to describe and synthesize hope and mental health in young adults in college. PubMed, CINAHL, and PsycINFO were searched for articles published in peer-reviewed journals from 2011-2016. Twenty empirical works were selected for inclusion and five themes emerged: (a) Hope is Associated With Improved Coping, (b) Hope is Associated With Improved Well-Being, (c) Hope is a Moderator Between Depression and Negative Life Events, (d) Hope is a Protective Factor in Suicide, and (e) Hope is a Factor in Healthy Behavior Engagement. Hope may be a protective factor in suicide and negative, self-deprecatory thinking. Further research is needed to determine if increasing hope in young adult college students will decrease the risk of suicide and non-suicidal self-injury, increase healthy behavior engagement, and improve coping and well-being. [Journal of Psychosocial Nursing and Mental Health Services, 55(2), 28-35.].
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http://dx.doi.org/10.3928/02793695-20170210-04DOI Listing
February 2017

The Role of Hope for Adolescents with a Chronic Illness: An Integrative Review.

J Pediatr Nurs 2016 Jul-Aug;31(4):404-21. Epub 2016 Mar 22.

College of Nursing University of Massachusetts, Amherst, MA.

Unlabelled: Hope is a human strength essential for adolescents' enduring and coping with chronic illness however, the role of hope is not well understood in this population.

Objectives: This integrative review describes what is currently known about the role of hope in adolescents with a chronic illness.

Method: A methodological review using an integrative approach by R. Whittemore and K. Knafl (2005) was performed.

Databases: MEDLINE via Pubmed; CINAHL; PyscINFO and Google scholar were searched for articles published in peer-reviewed journals from 1995 to 2015, using search terms 'hope and chronic illness' with age limiters for all except Google scholar (title search of "hope and adolescents").

Results: Of the 197 studies initially retrieved: a total of 27 quantitative studies, 8 qualitative studies and 19 theoretical works were selected for review. Seven themes emerged including that hope: (i) promotes health (ii) facilitates coping and adjustment, (iii) enhances quality of life, (iv) is essential in purpose in life and illness (v) improves self-esteem, (vi) is an important factor in resilience and (vii) affects maturation. Persons reporting higher levels of hope find multiple routes to goals, view setbacks as challenges, and better manage psychological symptoms.

Discussion: Although theory and a limited body of empirical research to date suggest a link between hopeful thinking and physical health, the specific mechanisms remain unclear. As hope is linked to resilience, further research should explore whether adolescents with higher hope return to baseline faster than their lower hope counterparts.
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http://dx.doi.org/10.1016/j.pedn.2016.02.011DOI Listing
August 2017
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