Tappen, Ruth M.

Resilience has been suggestive of successful aging. However, the resilience literature lacks a well-developed theoretical model of resilience in later life for diverse groups. The purpose of this study was to examine and compare the resilience and its predictive factors in participants 60 years and older from the U.S. and Nepal.
Secondary data from the Healthy Aging Research Initiative and newly collected data from Nepal were analyzed. Independent t-test using Welch’s test was used to assess the differences in resilience, functional activity, frailty, social support, personality, spirituality, physical health, and mental health of participants between the two countries. One-way analysis of variance and multiple comparisons of the groups using the Games-Howell post hoc test was conducted to assess the differences in resilience of participants across groups of ethnicities, frailty status, and religious attendance. Pearson correlations were used to assess the relationship of resilience with independent variables. Backward elimination regression was used to identify the predictive factors of resilience. The model fit for the constructed conceptual model in the study was tested by Structural equation modeling.

Moral comfort, an emerging concept in nursing, is defined as an individual’s feelings of ease with decisions and actions related to a moral dilemma. Moral comfort for nurses is the positive outcome of a moral situation or dilemma, while moral distress, a widely explored issue in nursing, is the negative outcome. However, nursing literature on the concept of moral comfort is limited. While several instruments to measure moral distress exist, an instrument to measure moral comfort was not found. The Moral Comfort Questionnaire (MCQ) was theoretically developed. The purpose of this study was psychometric evaluation of this new 35-item instrument.
Direct-care hospital-based registered nurses (n = 466) participated from February
2019 to September 2019 in this IRB-approved study. Participants completed demographic information, the MCQ, and the Moral Distress Scale revised (MDSR). Psychometric evaluation included a priori content validation and multiple statistical analyses: Cronbach’s alpha, Spearman’s correlation coefficient, weighted kappa, Bland- Altman analysis (B&A), discriminant validity, and confirmatory factor analysis (CFA).

With large numbers of Americans over 65 years of age, millions of elderly individuals
could be at risk for swallowing disorders or dysphagia. These disorders can greatly affect
a person’s quality of life and health. While the aging process in a healthy individual does
not necessarily lead to impaired swallowing, aging can lead to changes in the swallowing
process, known as presbyphagia (Robbins, et al., 1992). Further data is needed regarding
prevalence, effects of lifestyle, and relationship with fatigue and swallowing abilities in healthy aging
individuals. The purpose of this study was to: investigate the prevalence of self-reported swallowing
difficulties in a healthy aging population; determine if age, ethnicity, or gender impact whether healthy
aging individuals perceive swallowing problems; and, if individuals reporting swallowing difficulties
experience avoidance of social situations or if fatigue relates as a factor in presbyphagia. A significantly
greater proportion of Hispanic Americans indicated swallowing difficulties than expected by chance,
18.8% "No" vs. 40.5% "Yes" (p = .0035). Further analysis indicated those who self-reported swallowing
difficulties were less socially engaged (t = 1.75, p = .048) and, for people who self-reported swallowing
difficulties a significant correlation between reduced social aspects of life and increased level of fatigue
(r = -.473, p = .003).Previous studies have reported mealtime anxiety and avoidance of eating with
other people in elderly individuals (Ekberg, 2002). Overall, the negative social impact from
presbyphagia can seriously affect an individual’s quality of life, however, early identification of
swallowing difficulties and remediation may be beneficial.

The use of the telephone to speak to study participants about health-related issues is
useful when logistics make it difficult for participant and researcher to meet in person. However,
gaining the trust of the participant can be a challenge, partly due to fears of fraud and identity
theft. A spirit of openness and caring must come across the telephone lines between interviewer
and interviewee. Roach’s six C’s can be applied to convey a sense of caring, thereby relaxing the
participant and increasing their sense of safety to enhance the quantity and quality of health data
being collected. According to Roach, caring is manifested through six C’s – compassion,
competence, confidence, conscience, commitment, and comportment. Interviewers can be trained
through role playing and scripting using Roach’s caring model. Compassion is expressed by
being sensitive to the anxiety and apprehension they may feel toward receiving a call from a
stranger, who is asking about health-related issues. Competence is expressed by being able to
give the participant the information they need to have an understanding as to what they are
consenting. Confidence is achieved by ensuring the participant that the information they share
will be used appropriately and for the greater-good. Conscience is expressed by following ethical
research protocols, adhering to confidentiality, and respecting the relationship with the research
participant. Finally, interviewers manifest caring through comportment by identifying
themselves with their name, credentials, and institution; addressing the participant formally;
using language the participant can understand; and projecting caring through tone of voice.

Background: A global cervical cancer health disparity persists despite the demonstrated success of
primary and secondary preventive strategies, such as cervical visual inspection (VI). Cervical
cancer is the leading cause of cancer incidence and death for women in many low resource
areas. The greatest risk is for those who are unable or unwilling to access screening. Barriers
include healthcare personnel shortages, cost, transportation, and mistrust of healthcare providers
and systems. Using community health workers (CHWs) may overcome these barriers, increase
facilitators, and improve participation in screening for women in remote areas with limited access
to clinical resources.
Aim: To determine whether the accuracy of VI performed by CHWs was comparable to VI by
physicians or nurses and to consider the affect components of provider training had on VI
accuracy.
Methods: A systematic review and quantitative meta-analysis of published literature reporting on VI
accuracy, provider type, and training was conducted. Strict inclusion/exclusion criteria, study
quality, and publication bias assessments improved rigor and bivariate linear mixed modeling (BLMM) was used to determine the affect of predictors on accuracy. Unconditional and
conditional BLMMs, controlling for VI technique, provider type, community, clinical setting, HIV
status, and gynecological symptoms were considered.
Results: Provider type was a significant predictor of sensitivity (p=.048) in the unconditional VI
model. VI performed by CHWs was 15% more sensitive than physicians (p=.014). Provider type
was not a significant predictor of accuracy in any other models. Didactic and mentored hours
predicted sensitivity in both BLMMs. Quality assurance and use of a training manual predicted
specificity in unconditional BLMMs, but was not significant in conditional models. Number of
training days, with ≤5 being optimal, predicted sensitivity in both BLMMs and specificity in the
unconditional model.
Conclusion: Study results suggest that community based cervical cancer screening with VI conducted
by CHWs can be as, if not more, accurate than VI performed by licensed providers. Locally based
screening programs could increase access to screening for women in remote areas.
Collaborative partnerships in “pragmatic solidarity” between healthcare systems, CHWs, and the
community could promote participation in screening resulting in decreased cervical cancer
incidence and mortality.

Although not all persons with mild cognitive impairment (MCI) go on to develop Alzheimer's disease (AD), MCI is recognized as an early stage of AD. The effects of AD are devastating to all concerned. Research has identified that recognition of AD in its earliest stages and institution of known treatment modalities can forestall the ultimate outcome. Identification of the first subtle signs of MCI can assist in the recognition of this prodromal phase, and allow for institution of therapy while still in the initial stages. Unfortunately, the development of MCI is insidious in nature, thus making it difficult to detect. The purpose of this study was to identify areas of functional decline that occur in MCI in an effort to improve its early identification. A mixed-methods design that combined qualitative and quantitative methods was used. Fifty-three participants with memory complaints were interviewed using a semi structured interview technique with open-ended questions, the Montreal Cognitive Assessment (MoCA), the Geriatric Depression Scale (GDS) and a list of eighty-five items previously identified as indicative of functional decline. Twenty-nine persons were divided into two groups: 1) those identified as probable MCI (consensus diagnosis) (n=15) and possible MCI (based on screening examination) (n=14) and 2) those identified as Normal (no cognitive impairment) (n=10), and their subjective functional deficits compared. The findings suggest that there were certain areas of functional decline more commonly experienced by persons in the MCI group than by unimpaired. These include difficulty recalling details of information and forgetting conversations. There were also other changes identified, such as adaptations on the part of persons with MCI (an increased dependence on memory aids, for example, lists and calendars) and a dec rease in social activities leading to an increase in social isolation. Additionally identified were functional activities that appear to remain intact in persons with early MCI. This study highlights the subtlety with which MCI assaults the functional abilities of individuals, thus making its early identification problematic. The results of this study will contribute by providing information that will help professionals who are assessing persons experiencing memory issues for the possible presence of MCI. Additionally, it is hoped that these findings will assist in the development of a measurement tool designed to assess for possible MCI.

Nursing care is considered a primary predictor of patient assessment of the overall
hospital experience. Yet, quality nursing care remains difficult to define. Limited
research about nurse or patient perspectives on what constitutes quality nursing care in
hospital settings prevents the identification of a shared description or insight into their
possible interrelationship. Research about nurse and patient descriptions is needed to
establish behaviors, attributes, and activities associated with quality nursing care to
improve the health and well-being of hospitalized patients.

Patients who are hospitalized and are without voice would like to participate in
their care. This requires clear communication. Speak for Myself™ (SFM) was developed
for use at the bedside so that communication may be facilitated between patient and nurse when the patient is voiceless. The objective of this study was to evaluate Speak for Myself™ at the bedside and to measure the outcomes. This was a mixed methods, one group pre-test-post-test, quasi-experimental study. Twenty adult patients in three
hospitals in South Florida agreed to use Speak for Myself™ during their acute care
hospital stay (M = 8.86 hours). This group of participants (n = 20) ranged from 45 to 91
years old (males = 14; females = 6). Of the participants, 15 (75%) self-identified as
European American, 2 (10%) self-identified as Hispanic, 2 (10%) self-identified as
African American, and 1 (5%) self-identified as Asian. Ten of the participants (50%)
were in respiratory failure. Two (10%) were receiving oxygenation measures related to
unspecified complications of their illnesses. Of the remaining eight participants (40%),
one each was receiving oxygenation measures due to atrial fibrillation, arteriosclerotic
heart disease, cardiogenic shock, endocarditis, neck abscess, renal failure, status post
seizure activity, and tongue metastasis.

Researchers have reported a high prevalence of depression among older Hispanics
in the United States when compared to other ethnic groups. Cultural variations in the
perception of depression sometimes make it difficult to recognize the disorder resulting in
older Hispanic patients not being diagnosed and not receiving appropriate treatment. The
purpose of this study was to explore older Hispanics’ explanatory model of depression
and identify culture-specific factors that may help in the recognition and treatment of
depression. A mixed-method design that combined qualitative and quantitative methods
was used. Fifty participants were interviewed using Kleinman’s Explanatory Models
ethnographic approach with a vignette variation, the Center for Epidemiologic Studies
Depression Scale (CES-D), and the Cross Cultural Measure of Acculturation (CCMA).
The findings suggest that this group of older Hispanics did not recognize
depression as an illness but rather as the result of life stressors and personal weaknesses.
People who experience depressive symptoms were described as being crazy, bored,
worried, or having a problem of the nerves. These culturally coded terms may confound diagnosis among many Hispanics who find depression an unacceptable and shameful
condition. This cultural pattern seemed to prevail among low and high-acculturated
individuals which may complicate the diagnosis of depression by health care providers.
This study highlights the complexity and diversity of this group of older
Hispanics’ conceptual model of depression. The results of this study will contribute to
nursing care by providing additional information that will help professionals when
working with Hispanic patients with depression. Findings expand our understanding of
older Hispanics (high and low-acculturated, depressed and non-depressed) groups’
conceptualization of depression and can be used to inform the adaptation of culturally
relevant approaches to better serve the Hispanic community in this country.

The purpose of this research project is to investigate the impact adult day care centers have on cognitively impaired older adults and their caregivers. I extracted data from records of the Louis and Anne Green Memory and Wellness Center participants who have given consent and attended the center for a minimum of six months. I have discovered that participants benefit from this day center because they experience an improved quality of life, maintain a higher level of functioning, have more opportunities for socialization, and establish friendships and connections. Caregivers of participants enrolled in the day center also benefit because they receive access to caregiver support groups, are temporarily freed from the responsibility to care, and are pleased that participants attend the center and enjoy attending the center. These findings contribute to the current body of research literature that supports the contributions of adult day care centers.