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Browsing by Author "Fulton, Janet S."
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Item Cancer Treatment-Related Fatigue: Psychometric Testing of the Cancer Treatment-Related Fatigue Representation Scale (CTRFRep) in Patients Undergoing Radiation Treatment for Cancer(2010-02-02T21:24:42Z) Reuille, Kristina M.; Welch, Janet L.; Keck, Juanita F.; Fulton, Janet S.; Friesth, Barbara ManzCancer treatment-related fatigue (CTRF) is recognized as a prevalent and bothersome symptom for patients with cancer. In a model of the CTRF experience, CTRF representation, or the beliefs, thoughts and emotions surrounding the experience of CTRF, is believed to mediate the relationship between CTRF intensity and CTRF distress. To date, there is no reported measure of CTRF representation. The purpose of this descriptive, cross-sectional study guided by Leventhal’s Common Sense Model of Self-Regulation was to evaluate an instrument designed to measure CTRF representation, the CTRF Representation scale (CTRFRep), based on an existing measure, the Illness Perception Questionnaire (IPQ-R). The study included 47 patients (mean age=57.7 years) receiving radiation therapy for cancer interviewed one month post-treatment. 77% of patients had fatigue during treatment. Three content experts and one theory expert assessed content validity of the CTRFRep. The content experts included three behavioral oncology nurse researchers whose focus is on symptom management and/or fatigue. The theory expert was a nurse researcher who is an expert in the area of self-regulation theory. As tested, the CTRFRep consisted of 105 items in 10 subscales addressing beliefs about the Identity, Timeline (Acute vs. Chronic/Cyclical), Consequences (positive/negative), Cause, Control (Treatment/Personal), Symptom Coherence, and Emotional Representation of CTRF. When evaluating psychometrics, the Identity and Cause subscales are analyzed independent of the other subscales. For the Identity subscale, symptoms most reported as related to CTRF were lack of energy, loss of strength, and feeling blue. For the Cause subscale, the most common beliefs regarding causes of CTRF were cancer treatment(s), having cancer, and stress or worry. Results indicate adequate reliability in six of eight remaining subscales (α>=0.70); the item N in those subscales was reduced from 56 to 34. To address construct validity, logistic regression assessed whether CTRFRep mediated the relationship between CTRF intensity and CTRF distress. After controlling for negative affect, the Identity and Consequences subscales were significant mediators – the Acute vs. Chronic Timeline and Emotional Representation scales were partial mediators – of the relationship between CTRF intensity on CTRF distress. These findings indicate fatigue is a problem for people undergoing treatment for cancer, and the CTRFRep may be a reliable and valid measure of CTRF representation for patients undergoing radiation treatment for cancer. Small sample size prevented successful factor analysis of the CTRFRep. Further research of the CTRFRep is warranted.Item A Celebration Like No Other(Wolters Kluwer, 2021) Fulton, Janet S.; School of NursingThe year 2020 may be gone and, as the designated Year of the Nurse and Midwife, not celebrated as planned. In answering the call to care in a worldwide pandemic, nurses have much to be proud of. As 2021 rolls around, much remains to be done.Item Description of Work Processes Used by Clinical Nurse Specialists to Improve Patient Outcomes(Elsevier, 2019) Fulton, Janet S.; Mayo, Ann; Walker, Jane; Urden, Linda D.; School of NursingItem Executive summary: Indiana Schools of Nursing substance abuse education(2022) Oruche, Ukamaka M.; Adams, Nicole; Xu, Jiayun; Crowder, Sharron; Cangany, Martha; Bracale, Jolene; Ofner, Susan; Fulton, Janet S.Item How Older Adult Caregivers Manage Wound Care Procedures, Resources Needed, and Public Policy Implications(2022-10) Swartzell, Kristen Leigh; Fulton, Janet S.; von Gaudecker, Jane R.; Bartlett Ellis, Rebecca J.; Huber, LesaAs healthcare increasingly shifts to home and community-based settings, informal caregiver responsibilities are increasing beyond assistance with activities of daily living to include complex care procedures previously performed by licensed caregivers in clinical settings. With an aging population, increasing numbers of older adults are assuming a caregiving role, a trend that is projected to continue into the foreseeable future. These older caregivers performing complex care procedures such as wound care. The purpose of this dissertation study was to understand how older adult caregivers manage complex wound care procedures. Aims were to 1) develop a theory for how caregivers manage; 2) identify themes related to resources needed, and 3) determine resources available through the existing Medicaid 1915(c) waivers program. Aims 1 and 2 were achieved using qualitative analysis of interviews with 18 older adult caregivers aged 65 and older who were performing wound care in the home for a care recipient. Grounded theory methods were used to develop a theoretical framework describing the process of how the participants managed caregiving. The resultant theory, Pushing Through, consisted of five phases: 1) accepting the role, 2) lacking confidence, 3) creating a system, 4) trusting in self, 5) owning the outcomes. Secondary analysis of the interview data used thematic analysis methods to identify resources used or needed for the caregiver role. The resultant themes were (a) connection to a healthcare professional, (b) written instructions, (c) access to wound care supplies, (d) access to durable medical equipment, (e) financial resources, (f) personal care coverage, and (g) socialization and emotional support. Aim 3 used descriptive analysis of Medicaid 1915(c) home- and community-based services waivers for adults aged 65 and older for all 50 states plus the District of Columbia to identify the frequency and type of waiver services available for supporting caregivers. Results revealed that the number of services offered by state Medicaid waiver programs varied greatly across the country. Respite in varying forms was the most frequently available service. Findings from this dissertation will contribute to the development of evidence-based strategies to sustain older adult caregivers within their caregiving role.Item An Interprofessional Yearlong Geriatrics Fellowship Program for Advanced Practice Nursing and Social Work Students(Wolters Kluwer, 2022-09) Glassburn, Susan L.; Westmoreland, Glenda R.; Frank, Kathryn I.; Fulton, Janet S.; Garrison, Emilie; Roth, Sarah; Litzelman, Debra K.; School of Social WorkBackground: The care of older adults with complex medical conditions requires effective team-based care. Problem: Nursing and social work students need a curriculum that provides them with immersive experiences in geriatrics to prepare them for competent practice. Approach: This Geriatric Workforce Enhancement Program supported 5 advanced practice nursing (APN) and 5 master of social work (MSW) student fellows in a 2-semester program, with 3 cohorts completing the fellowship over 3 years (N = 30). Outcomes: By the completion of the fellowship, students had (1) demonstrated increased knowledge of age-related changes and health problems experienced by older adults, (2) developed clinical competencies in providing patient-centered health care for older adults, and (3) assessed the fellowship as helpful in preparing for interprofessional team care. Conclusions: An interprofessional gerontology fellowship for APN and MSW students can develop knowledge and skills in team-based care for older adults. Recommendations for creating a fellowship curriculum are provided.Item The Role and Practice of Clinical Nurse Specialist in Nigeria(Springer, 2021) Obichi, Chidiebele Constance; Anieche, John Emenike; Osuala, Eunice Ogonna; Oruche, Ukamaka M.; Fulton, Janet S.; Holly, Vincent W.Although the clinical nurse specialist was recognized as an expert practitioner in the United States for 50 years, there is an absence of a framework for the clinical nurse specialist role in Nigeria. There are three pathways through which the federal government, state government, and private sector provide specialist education and training for nurses in Nigeria. Nurses who have received graduate education should practice to the full extent of their education and training. Also, nurses who have their practice expanded in the treatment of communicable diseases and reproductive, maternal, newborn, and childcare should be appropriately recognized. This chapter explores challenges to developing the clinical specialist nurse role in Nigeria and the extent to which the clinical nurse specialist role is evolving in Nigeria through specialist education and training for nurses. Regardless of the pathway, setting, or specialty, Nigerian nurses may have achieved many clinical nurse specialist core competencies without a formal master’s education. Hence, Nigeria is long overdue for the development, recognition, and legal inclusion of the clinical nurse specialist role and practice in the career structure of nurses at all levels of the Nigerian health system.Item The Symptom Experience of Patients With Advanced Pancreatic Cancer: An Integrative Review(Lippincott, Williams, and Wilkins, 2017-01) Tang, Chia-Chun; Von Ah, Diane; Fulton, Janet S.; School of NursingBackground: Pancreatic cancer is a devastating disease with limited treatment options. More than 80% of pancreatic cancers are diagnosed in advanced stages and often have debilitating symptoms, making symptom management paramount, yet the symptom experience of patients with advanced pancreatic cancer (APC) is not well understood. Objective: The purpose of this integrative review is to synthesize the current evidence regarding the symptom experience of patients with APC. Method: An integrative literature review was conducted to identify the patient symptom experience in studies published from 2005 to 2015. Results: Sixteen studies met the inclusion criteria. All studies used a quantitative approach; 44% were quasi-experimental, 31% were descriptive, and 25% were correlational. Physical symptoms, especially pain, were the primary focus in most studies. Fatigue, loss of appetite, and impaired sense of well-being were prevalent and reported by patients to be of high intensity. Few studies examined psychological symptoms in patients with APC, although anxiety and depression were noted. Conclusion: Findings suggest that physical and psychological symptoms are prevalent, some with high intensity. Preselection of symptom inventories limits our ability to fully understand the symptom experience of patients with APC. Future qualitative work is needed to provide a more in-depth understanding of symptoms, especially symptom quality and distress level, from patients' perspectives. More studies are needed to explore psychological symptoms and the interaction of physical and psychological symptoms. Implications for Practice: Findings help healthcare givers to better understand the symptom experience of their APC patients.Item Using Our Voice(Wolters Kluwer, 2022) Fulton, Janet S.; School of Nursing