Exploring the Interrelationships Between Physical Function, Functional Exercise Capacity, and Exercise Self-Efficacy in Persons Living with HIV

PURPOSE

To determine if there were differences between the subjective and objective assessments of physical activity while controlling for sociodemographic, anthropometric, and clinical characteristics.

SETTING/SAMPLE

A total of 810 participants across eight sites located in three countries.

MEASURES

Subjective instruments were the two subscales of Self-efficacy for Exercise Behaviors Scale: Making Time for Exercise and Resisting Relapse and Patient-Reported Outcomes Measurement Information System, which measured physical function. The objective measure of functional exercise capacity was the 6-minute Walk Test.

ANALYSIS

Both univariate and multivariant analyses were used.

RESULTS

Physical function was significantly associated with Making Time for Exercise (β = 1.76, p = .039) but not with Resisting Relapse (β = 1.16, p = .168). Age (β = -1.88, p = .001), being employed (β = 16.19, p < .001) and race (βs = 13.84-31.98, p < .001), hip-waist ratio (β = -2.18, p < .001), and comorbidities (β = 7.31, p < .001) were significant predictors of physical functioning. The model predicting physical function accounted for a large amount of variance (adjusted R2 = .938). The patterns of results predicting functional exercise capacity were similar. Making Time for Exercise self-efficacy scores significantly predicted functional exercise capacity (β = 0.14, p = .029), and Resisting Relapse scores again did not (β = -0.10, p = .120). Among the covariates, age (β = -0.16, p < .001), gender (β = -0.43, p < .001), education (β = 0.08, p = .026), and hip-waist ratio (β = 0.09, p = .034) were significant. This model did not account for much of the overall variance in the data (adjusted R2 = .081). We found a modest significant relationship between physical function and functional exercise capacity (r = 0.27).

CONCLUSIONS

Making Time for Exercise Self-efficacy was more significant than Resisting Relapse for both physical function and functional exercise capacity. Interventions to promote achievement of physical activity need to use multiple measurement strategies.

Health and Racial Disparities: Importance of Accurate and Reliable Ethnicity, Race, and Language Data

Introduction: Accurate demographic data are essential to identify and monitor differences, trends, and changes in diabetes-related conditions between Hispanics and non-Hispanic Blacks (NHBs). It also provides pertinent information to reduce health and racial disparities among English- and Spanish-speakers. Method: The study's design was a quantitative cross-sectional one. Electronic medical record (EMR) and survey data of the same sample were compared. Descriptive statistics were computed for ethnicity, preferred language, and physiological data. Frequency and percentages were calculated for each continuous and categorical variable. Chi-square was calculated to compare physiological variables by ethnicity and language. Results: During a 5-month period (September 2021-February 2022), 106 individuals from New York City with diabetes took part in this study. Among Hispanics, most from the EMR identified as Other (82.4%), whereas from the survey, most identified as White (57.1%). More Hispanics (19%) and Spanish speakers (18%) had high triglyceride levels compared to NHBs (2%) and English speakers (3%). Conclusion: Ensuring that demographic data are accurate can better inform programs. Because Hispanics and Spanish speakers had the highest triglyceride levels, diabetes programs need to include information on cardiovascular disease and must be available in Spanish, to further reduce risk factors, improve health outcomes, and promote health equity among these populations.

Intent to stay, moral distress, and nurse practice environment among long-term care nurses: A cross-sectional questionnaire survey study

BACKGROUND

Many long-term care facilities in the United States face significant problems with nurse retention and turnover. These challenges are attributed, at least in part, to moral distress and a negative nurse practice environment.

OBJECTIVE

The purpose of the study was divided into two parts: first, to investigate the relationships among nurse practice environment, moral distress, and intent to stay; second, to explore the potential mediating effect of the nurse practice environment on the intent to stay among those with high levels of moral distress.

DESIGN

This study was a descriptive, cross-sectional survey using targeted sampling.

PARTICIPANTS

A total of 215 participants completed the surveys. Participants were nationally representative of long-term care nurses by age, years of experience, employment status, and type of health setting.

METHODS

This study was an online national survey of long-term care nurses' perceptions of their intent to stay, moral distress level (Moral Distress Questionnaire), and nurse practice environment (Direct Care Staff Survey). Structural equation modeling analysis explored intent to stay, moral distress, and the nurse practice environment among long-term care nurses.

RESULTS

The mean moral distress score was low, while the mean nurse practice environment and intent to stay scores were high. Moral distress had a significant, moderately negative association with the nurse practice environment (β = -0.41), while the nurse practice environment had a significant, moderately positive association with intent to stay (β = 0.46). The moral distress had a significant, moderately negative association with intent to stay (β = -0.20). The computed structural equation modeling suggested a partially mediated model (indirect effect = -0.19, p = 0.001).

CONCLUSION

Since the nurse practice environment partially mediates the relationship between moral distress and intent to stay, interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.

CLINICAL RELEVANCE

Our study demonstrated that the nurse practice environment mediates moral distress and intent to stay. Interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.

Moral distress in long-term care questionnaire modification and psychometric evaluation

BACKGROUND

Licensed nurses working in long-term care facilities experience ethical challenges if not resolved can lead to moral distress. There is a lack of an English-language validated tool to adequately measure moral distress in the long-term care setting.

AIMS

To describe the modification and psychometric evaluation of the Moral Distress Questionnaire.

METHODS

Instrument development and psychometric evaluation. Internal consistency using Cronbach's α to establish reliability was conducted using SPSS version 27.0 while SPSS Amos version 27.0 was used to perform a confirmatory factor analysis of the Moral Distress Questionnaire.

PARTICIPANTS

A national sample of US-licensed nurses who provided direct resident care in long-term care settings were recruited via a targeted sampling method using Facebook from 7 December 2020 to 7 March 2021.

ETHICAL CONSIDERATION

The study was approved by the university's human research protection program. Informed consent was provided to all participants.

RESULTS

A total of 215 participants completed the surveys. Confirmatory analysis indicated that the 21-item scale with a 4-factor structure for the Moral Distress Questionnaire model met the established criteria and demonstrates an acceptable model fit (CMIN/DF = 2.0, CFI = 0.82, TLI = 0.77, RMSEA = 0.07). Factor loadings for each item depict a moderate to a strong relationship (range 0.36-0.70) with the given underlying construct. Cronbach's α coefficient was 0.87 for the overall scale and 0.60-0.74 for its subscales which demonstrate good reliabilities.

DISCUSSION

This is the first English-language validated tool to adequately measure moral distress in the long-term care setting experienced by US long-term care nurses. This reliable and well-validated tool will help identify moral distress situations experienced by US long-term care nurses.

CONCLUSION

The modified 21-item English version of the Moral Distress Questionnaire is reliable tool that demonstrates good psychometric properties to validly measure sources of moral distress among direct resident care nurses.

Comorbidities in older adults with opioid use disorders

BACKGROUND

There is a growing number of opioid use disorders (OUDs) and overdose deaths in older adults. In addition, older adults with OUD routinely receive lower-quality preventive and chronic care that result in poorer overall health.

PURPOSE

The purpose of this study was to identify older patients with OUD at the study site and determine the prevalence of medical and psychiatric comorbidities.

METHODOLOGY

This retrospective study used a computer algorithm employed by a network of Federally Qualified Health Center primary care clinics in lower New York state. With the approval from institutional review board, the IT department of the organization captured data about older adults with an OUD diagnosis. The IT department identified 664 patients and provided anonymized demographic and medical history data of these patients for analysis.

RESULTS

Patients with OUD had 2-3 times more medical and psychiatric co-occurring conditions than national sample of older adults with no OUD of similar age and income. The most frequent co-occurring medical conditions in the patients were heart or circulatory disorders, movement disorders, respiratory disorders, pain disorders, nutritional disorders, and metabolic disorders. The most common co-occurring psychiatric conditions were anxiety disorders, major depressive disorder, post-traumatic stress disorder (PTSD), and bipolar disorder.

CONCLUSIONS

Older adults with OUD often have complex health care needs that often include one or more chronic medical and psychiatric conditions.

IMPLICATIONS

Providers should be aware of the multiple needs of older adults with OUD so that appropriate and comprehensive care can be offered to the patients.

Canine-Assisted Interventions and the Relevance of Welfare Assessments for Human Health, and Transmission of Zoonosis: A Literature Review

CAIs (canine-assisted interventions) include "canine-assisted therapy" in which a therapist sets client-oriented goals, 'canine-assisted activities' with recreational goals for clients, and 'canine-assisted education/learning' in which teachers or coaches create learning goals for students or clients. CAIs vary in nearly every way; their only common trait is the involvement of dogs to respond to human need. However, the benefits of involving dogs are highly dependent on the animal's health and behavior. A dog exhibiting negative behavior or an unwell dog might pose a risk, especially for CAI target groups, specifically individuals with immunosuppression, chronic illness, children, elderly, etc. Therefore, positive animal welfare as preventative medicine to avoid incidents or transmission of zoonosis is an attractive hypothesis, with implications for human and animal, health and well-being. This review aims to summarize the current published knowledge regarding different aspects of welfare in CAIs and to discuss their relevance in the light of health and safety in CAI participants. As method for this study, a literature search was conducted (2001-2022) using the Prisma method, describing issues of dog welfare as defined in the Welfare Quality® approach. This welfare assessment tool includes 4 categories related to behavior, health, management, and environment; it was, therefore, applicable to CAIs. Results indicate that dogs working in CAIs are required to cope with diverse variables that can jeopardize their welfare. In conclusion, we propose regular welfare assessments for dogs in CAIs, which would also protect the quality of the CAI sessions and the clients' safety and well-being.

Tests of Revisions to the Norbeck Social Support Questionnaire

Objectives

To compare the accuracy of averaged scores from the original Norbeck Social Support Questionnaire (NSSQ)and averaged scores from each of three new NSSQ versions (NSSQ-R.aid, NSSQ-R.n/a, and NSSQ-R.format). These three new versions of the widely used NSSQ were developed to address three previously identified concerns regarding score accuracy: the Aid subscale's examples of aid, lack of an n/a response option, and the network nomination/rating procedure. Missing data rates were also assessed.

Methods

A convenience sample (N = 223) completed one of the four NSSQ versions. Score accuracy (restriction) was assessed by size of correlation between averaged scores (averaged score/network size) and network size, with low correlations indicating less score restriction and higher score accuracy. Fisher's r-to-z transformations assessed the significance of the difference between all correlations from the three versions. Missing data rates were assessed using chi-square tests of independence.

Results

The cumulative effects of removing the aid examples and use of the n/a response option improved score accuracy; averaged Aid scores from the NSSQ-R.n/a were statistically significantly less restricted than corresponding scores on the original NSSQ. The final version (NSSQ-R.format) actually resulted in statistically significant decreased score accuracy for averaged Affect scores. There were no statistically significant differences in missing data rates among versions.

Conclusion

Averaged scores from the NSSQ-R.n/a should be used. Future research should focus on the use of situation-specific Aid items.

Identifying and Addressing Sources of Measurement Error in the Norbeck Social Support Questionnaire

Background and Purpose: The Norbeck Social Support Questionnaire (NSSQ) provides a rich portrait of one's perceived social support including network size/composition and quality of support. Analyses of quantitative research reports and critiques of the NSSQ revealed non-negligible measurement error. We document evidence of measurement error, report potential sources of this error, and present forthcoming psychometric testing. Methods: Quantitative evidence of measurement error from the NSSQ literature provided the basis for initial hypotheses concerning sources of error in network nomination and support ratings. We then conducted cognitive interviews to investigate these hypotheses. Results: Cognitive interviews revealed evidence of respondents' miscomprehension and response option bias. Conclusions: The current nomination process coupled with the lack of a “not applicable” response option and embedded examples in tangible Aid items reduces the accuracy of NSSQ subscores.

Use of averaged norbeck social support questionnaire scores

Background. Averaged Norbeck Social Support Questionnaire (NSSQ) support scores remove the influence of network size variability but may unduly lower scores for participants with large networks. Objectives. To evaluate the use of averaged NSSQ scores. Method. Pearson correlations determined if averaged scores decreased as network size increased across three samples. Then, Pearson correlations between a criterion variable and both averaged and raw support scores were computed along with the resultant power to detect a true effect. Results. Neither averaged total functional support nor averaged affect and affirmation scores decreased as sample size increased. However, averaged aid scores did decrease as network size increased. Power also increased markedly in all averaged versus raw scores except in averaged aid scores. Discussion and Conclusions. Use of averaged aid scores is not recommended. Use of all other averaged scores appears acceptable.