Browsing by Author "Lu, Yvonne"
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Item Activation in persons with mental health disorders: An integrative review(Wiley, 2021-07-26) Keen, Alyson; Lu, Yvonne; Oruche, Ukamaka M.; Mazurenko, Olena; Burke Draucker, Claire; School of NursingWHAT IS KNOWN ON THE SUBJECT?: Evidence indicates a strong relationship between patient activation (i.e. confidence, knowledge and skills to self-manage health) and positive health behaviours and outcomes in a variety of clinical populations. Because persons with mental health disorders experience significant disease burden but often underutilize mental health treatment or experience poor treatment outcomes, they would likely benefit from increases in activation. No systematic reviews have been conducted to summarize and synthesize research on patient activation in persons with mental health disorders. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To our knowledge, this is the first comprehensive review to identify factors associated with activation and interventions that have shown to be effective in persons with mental health disorders. This integrative review indicates that better health status, less depression, positive health attitudes and behaviours, and higher quality therapeutic relationships may be associated with higher levels of activation in persons with mental health disorders. This review also indicates that a variety of interventions, most notably educational programs, are effective in increasing levels of patient activation in persons with mental health disorders. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Psychiatric mental health nurses and other clinicians should consider routine assessment of patient activation to inform individualized treatment plans for their clients. Clinicians should aim to form high-quality therapeutic relationships with clients as a way to promote higher levels of activation. Interventions that have been found to be effective in improving activation could be offered in a variety of mental health settings. ABSTRACT: Introduction Patient activation is understanding one's role in the healthcare process and having confidence, knowledge, and skills to self-manage one's health and health care. Researchers have begun to investigate patient activation in persons with mental health disorders, but no systematic reviews have been conducted to summarize and synthesize this research. For psychiatric mental health nurses and other clinicians to develop strategies to increase patient activation in this population, more information is needed about factors associated with activation and interventions that increase activation. Review Questions (1) What factors are associated with levels of activation in persons diagnosed with mental health disorders? (2) What interventions have shown to be effective at increasing levels of activation in persons diagnosed with mental health disorders? Method A 5-stage integrative review as described by Whittemore & Knafl. Results Twenty-nine articles were included in the review. Ten provided correlations between activation and other factors, and 20 examined the effects of interventions on activation. Some studies revealed significant correlations between a variety of health and treatment-related factors, and others revealed that some interventions, most notably educational programs, were shown to increase activation. Discussion The findings of this comprehensive review can inform psychiatric mental health nurses and other clinicians in developing strategies to increase activation in the patients with whom they work. More research is needed to provide a deeper understanding of the role of activation in the recovery and treatment of persons with mental health disorders. Implications for Practice Psychiatric nurses and other clinicians should assess for patient activation and incorporate strategies to increase levels of activation in patients in their practice. Positive therapeutic relationships likely enhance activation in persons with mental health disorders.Item Activation in Persons with Opioid Use Disorders in Intenstive Outpatient Treatment(2021-12) Keen, Alyson Yvonne; Lu, Yvonne; Draucker, Claire Burke; Oruche, Ukamaka; Mazurenko, OlenaPersons with opioid use disorder (OUD) often receive intensive outpatient treatment (IOT) but these programs are associated with low rates of completion and high rates of relapse. Enhancing patient activation - taking an active role in one’s healthcare - would likely improve outcomes for persons with OUD in IOT. The overarching purpose of this dissertation is to describe how persons with OUD experience IOT, especially regarding activation. The dissertation includes three components. The first is an integrative review of 29 studies of activation in persons with mental health disorders generally. Results revealed that activation was related to several heath and treatment-related factors and some interventions, most notably educational programs, increased activation. The second and third components were based on interviews with 14 persons who had been enrolled in an IOT program in academic health centers. The second component was a constructivist grounded theory study conducted to describe the process people undergo as they participate in an IOT program. Participants described a process of connecting and disconnecting that included eight stages: (1) connecting with drugs, (2) disconnecting from everyday life, (3) connecting with the IOT program, (4) connecting with others in the IOT program, (5) disconnecting from drugs, (6) reconnecting with others, (7) reconnecting with self, and (8) disconnecting from the IOT program. The third component was a qualitative descriptive study conducted to describe types of instances in which persons play an active role in their IOT (activation). Participants described six types of instances: (1) making and enacting one’s own treatment decisions, (2) actively engaging in treatment planning with staff, (3) choosing to actively engage in groups, (4) making a commitment to treatment, (5) taking responsibility for one’s own recovery, and (6) taking actions to avoid relapse. The results of this dissertation will inform the development of strategies to enhance activation among persons with OUD in IOT with the goal of improving engagement and program outcomes.Item Activities of Daily Living Recovery in Home Health Patients with Diabetes(Oxford University Press, 2023-12-21) Webster-Dekker, Katelyn; Lu, Yvonne; Perkins, Susan; Ellis, Jennifer; Otis, Laurie; Winton, Rebecca; Hacker, Eileen; School of NursingOlder adults with diabetes are at high risk for impairments in their ability to perform activities of daily living (ADLs). Home health (HH) services help patients regain their ability to perform ADLs after being hospitalized, but there may be disparities in degree of ADL improvement based on characteristics such as race/ethnicity. We aimed to identify factors associated with improvements in ADLs from the start of HH care to discharge in older adult (age ≥65) patients with diabetes receiving HH. This secondary analysis used Outcome and Assessment Information Set-D data collected between October 1, 2021, and March 31, 2022 in the Southern U.S by a HH agency. We used multiple linear regression to examine factors associated with improvement in ADL performance. The sample (n=1350) was 55% female and 76% White, with a mean age of 76.3 (SD 7.3). Ninety-seven percent of patients improved their ADL score from start of HH care to discharge. Black/African American race (b= -0.33) and having bowel incontinence or an ostomy (b= -0.51) were associated with less ADL improvement. Having a caregiver who needed training/support (b= 0.44) or was unlikely to provide assistance (b= 0.78), the presence of a surgical wound (b= 0.52), pain that interfered with activity (b= 0.46), confusion (b= 0.30), and better scores in prior functioning (b= 0.13) at the start of HH were associated with greater improvement in ADLs upon discharge from HH. These findings require further investigation, but indicate Black patients experienced disparities in ADL improvement which should be addressed.Item Change in Depression, Confidence, and Physical Function Among Older Adults With Mild Cognitive Impairment(Wolters Kluwer, 2019-09-01) Ellis, Jennifer L.; Altenburger, Peter; Lu, Yvonne; Physical Therapy, School of Health and Rehabilitation SciencesBackground and Purpose Nearly a quarter of those in the US over age 71 experience mild cognitive impairment (MCI). Persons with MCI (PwMCI) battle depression and progressive disengagement from daily activities, which contribute to participation restriction and activity limitation. Daily engagement in meaningful activity (DEMA) is a tailored intervention designed to benefit PwMCI and their caregivers through preserved engagement and supported adjustment to cognitive changes. This secondary analysis was guided by the International Classification of Functioning, Disability and Health (ICF) model. Aims were to (i) explore the extent to which change in self-rated activity performance and physical function can predict change in depressive symptoms, (ii) evaluate for difference in confidence and depressive symptoms at ICF levels of activity and participation, and (iii) quantify the impact of daily engagement at the ICF level of participation on physical function. Methods A secondary analysis was conducted using data from the parent study, which was a two-group randomized trial involving PwMCI and their informal caregivers participating in the Indiana Alzheimer Disease Center DEMA program. Quantitative analysis (dyads: DEMA N = 20, Information Support N = 20) examined outcomes at posttest and follow-up. Analysis employed linear regression to model the relationship between explanatory and dependent variables and independent t-test to examine for difference in confidence, depression, and physical function. Results and Discussion At posttest, change in self-rated performance predicted change in depressive symptoms. Those in the DEMA group who engaged in activity at the ICF level of participation demonstrated a significant increase in confidence and physical function. Although not significant, the control group posttest results showed a mean decrease in confidence. Conclusions Results demonstrate a positive impact of DEMA on depressive symptoms, confidence, and physical function. Change in occupational performance predicted change in depressive symptoms. Confidence significantly improved among those who engaged at the ICF participation level. A larger, randomized controlled longitudinal trial is needed to better assess the impact of DEMA on physical function, activity, participation restriction and quality of life.Item Community Centered Approaches to Increase Participation of African Americans in Brain Health and ADRD Research(Oxford University Press, 2022-12-20) Barnes, Priscilla; Cureton, Bianca; Jessup, Nenette; Sutton, Natalie; Hill, Carl; Shih, Patrick; Hendrie, Hugh; Lu, Yvonne; School of NursingAfrican Americans/Blacks continue to be underrepresented as participants in Alzheimer’s Disease and related dementia (ADRD) and brain research. Numerous challenges such as lack of information about the Alzheimer’s Disease and related dementia (ADRD), socioeconomic barriers, historical and systemic racism, and distrust of research goals and processes persist in research participation. Research approaches tend to be more recruitment oriented rather than partnership driven that do not address these challenges. As a result, community engagement approaches are increasingly being recognized as a means of building trust and creating new pathways for participation in ADRD studies. This poster focuses on the preliminary work of the Collaborative on Aging Research and Engagement (CARE) --- a community academic partnership comprising the CARE Advisory Team (a community action team of 10 African American leaders), Alzheimer’s Association, the Alzheimer’s Association Greater Indiana Chapter, IU Schools of Nursing, Public Health, and Informatics, Computer Science, and Engineering, and the Indiana Alzheimer’s Disease Research Center. The goal of the partnership is to facilitate active engagement of African Americans aged 45 years and older in research opportunities taking place in in Central and Northwest Indiana. Experiences and perspectives shared at the CARE Advisory Team meetings as well as memos from the researcher staff generated five lessons learned in building relationship oriented, as opposed to recruitment driven, processes. These lessons will be used to develop a community engagement framework focused on the integration of culturally relevant outreach practices in promoting ADRD research opportunities in African American/Black communities.Item Connecting and disconnecting: Experiences of people with opioid use disorder in intensive outpatient treatment(Elsevier, 2022-04) Keen, Alyson; Lu, Yvonne; Burke Draucker, Claire; School of NursingINTRODUCTION: Opioid use disorder (OUD) is a public health crisis affecting 2 million Americans. Approximately 80% of people with OUD do not receive treatment, and attrition rates in treatment programs are as high as 80%. Previous research has shown intensive outpatient treatment (IOT) has positive outcomes, but enrollment and retention in programs are problematic. To improve outcomes and increase engagement, more information is needed about how persons experience IOT programs. The purpose of this study is to describe processes that people with OUD undergo as they participate in IOT programs. METHODS: The research team conducted a constructivist grounded theory study in IOT programs at two adult academic health centers within a large Midwest health care system. Study staff conducted interviews with 14 persons to elicit narratives about their experiences in the IOT programs. The team transcribed and analyzed interviews using a four-step process consistent with grounded theory methods. RESULTS: Participants described the process of connecting and disconnecting as central to their IOT experience. The process included eight stages: (1) connecting with drugs, (2) disconnecting from everyday life, (3) connecting with the IOT program, (4) connecting with others in the IOT program, (5) disconnecting from drugs, (6) reconnecting with others, (7) reconnecting with self, and (8) disconnecting from the IOT program. CONCLUSIONS: Connections with the IOT program, other patients, and IOT staff are central to beginning sobriety. Findings indicate that clinicians should foster connections and provide a multi-dimensional experience that enables patients to begin recovery.Item Daily Engagement in Meaningful Activity for Home Care Patients with Subjective Cognitive Decline and Caregivers(Oxford University Press, 2023-12-21) Lu, Yvonne; Ellis, Jennifer; Perkins, Susan; Hickman, Susan; Chang, Pei-Shiun; Haase, Joan; Otis, Laurie; Winton, Rebecca; School of NursingPatients with subject cognitive decline (SCD) often lose sense of control, disengage from meaningful activities, and have less confidence in their ability to manage daily challenges. The objectives of pragmatic pilot phase study were to evaluate the feasibility and benefits of a Daily Engagement in Meaningful Activity Professional (DEMA-Pro) for patients with SCD; and explore nurses’ experience of DEMA-Pro implementation. Forty-nine patients at four home healthcare sites received six weekly DEMA-Pro telephone sessions. The Outcome and Assessment Information Set-D were collected at starting date (pre-intervention) and discharge date (post-intervention). Quantitative surveys and qualitative focus group methods were used to explore the DEMA-Pro nurses (n = 3) experiences. The consent rate was 67.1%, the completed intervention rate 36.7%, and the partial completed intervention rate 25.5%. For 36 subjects with discharge data available, both IADLs and self-care scores improved (d = 3.11 and d = 2.66, respectively). Specifically, those that completed all DEMA-Pro sessions (n=14), partial completers (n=12), and non-completers (n=10), had improved scores on IADLs (d = 4.0, 4.2, and 2.5, respectively) and Self-Care (d = 3.7, 3.1 and 2.0, respectively). Completers had greater improvement than non-Completers for both outcomes and greater improvement on IADLs than partial completers (all p-values < 0.03). Nurses reported high satisfaction with their training, and high confidence that the implementation of the intervention met patient and caregiver needs. The DEMA-Pro has shown benefits and feasibility that will need further testing in a large pragmatic trial in homecare settings.Item Effects of Qigong Exercise on Physical and Psychological Health among African Americans(Sage, 2021-06) Chang, Pei-Shiun; Lu, Yvonne; Nguyen, Chi Mai; Suh, Youngnok; Luciani, Mary; Ofner, Susan; Powell, Savannah; School of NursingInterventions are needed to address physical and psychological health in middle-aged and older African Americans (AAs). The purpose of this pilot study was to evaluate the feasibility and potential benefits of an eight-week Qigong exercise on physical ability and function, balance, frailty, depression and anxiety, and spiritual well-being in AAs using a single-group design. Fifteen AAs with a mean age of 64 years received Qigong exercise over 16 semi-weekly, one-hour sessions. The majority were female (93.3%) and college-level educated (53.3%). Repeat chair stands, physical function, and spiritual well-being improved significantly (p < .05) with effect sizes ranging from .45 to .87. Over 52% of participants showed improved depression scores, fast gait speed, and standing balance. Nearly 42% demonstrated some frailty improvement over baseline. No adverse events were reported. Qigong exercise potentially improves the physical ability and function, and spiritual well-being of AAs and needs further testing in a randomized clinical trial.Item In vitro comparison of gastric aspirate methods and feeding tube properties on the quantity and reliability of obtained aspirate volume(2013-11-20) Bartlett Ellis, Rebecca J.; Ellett, Marsha; Bakas, Tamilyn; Beckstrand, Janis; Fuehne, Joseph; Lu, YvonneGastric residual volume (GRV) is a clinical assessment to evaluate gastric emptying and enteral feeding tolerance. Factors such as the tube size, tube material, tube port configuration, placement of the tube in the gastric fluid, the amount of fluid and person completing the assessment may influence the accuracy of residual volume assessment. Little attention has been paid to assessing the accuracy of GRV measurement when the actual volume being aspirated is known, and no studies have compared the accuracy in obtaining RV using the three different techniques reported in the literature that are used to obtain aspirate in practice (syringe, suction, and gravity drainage). This in vitro study evaluated three different methods for aspirating feeding formula through two different tube sizes (10 Fr [small] and 18 Fr [large]), tube materials (polyvinyl chloride and polyurethane), using four levels of nursing experience (student, novice, experienced and expert) blinded to the five fixed fluid volumes of feeding formula in a simulated stomach, to determine if the RV can be accurately obtained. The study design consisted of a 3x2x2x4x5 completely randomized factorial ANOVA (with a total of 240 cells) and 479 RV assessments were made by the four nurse participants. All three methods (syringe, suction and gravity) used to aspirate RV did not perform substantially well in aspirating fluid, and on average, the methods were able to aspirate about 50% of the volume available. The syringe and suction techniques were comparable and produced higher proportions of RVs, although the interrater reliability of RV assessment was better with the syringe method. The gravity technique generally performed poorly. Overall, the polyvinyl chloride material and smaller tubes were associated with higher RV assessments. RV assessment is a variable assessment and the three methods did not perform well in this in vitro study. These findings should be further explored and confirmed using larger samples. This knowledge will be important in establishing the best technique for assessing RV to maximize EN delivery in practice and will contribute to future research to test strategies to optimize EN intake in critically ill patients.Item The Nexus of Sensory Loss, Cognitive Impairment, and Functional Decline in Older Adults: A Scoping Review(Oxford Academic, 2022-10) Liu, Chiung-ju; Chang, Pei-Shiun; Griffith, Cheryl F; Hanley, Stephanie I; Lu, Yvonne; School of NursingBACKGROUND AND OBJECTIVES: The prevalence of cognitive impairment and sensory loss in hearing or vision increases with age. Based on the Information Processing Model, cognitive impairment coupled with sensory loss may exacerbate disability in late life. Yet this issue has not been systematically studied. The purpose of this scoping review was to examine the literature that studied the relationship between cognitive impairment, sensory loss, and activities of daily living in older adults. RESEARCH DESIGN AND METHODS: Two reviewers independently screened 1,410 studies identified from 5 electronic databases (Medline, EMBASE, PsycINFO, CINHAL, and Web of Science). The search was completed in June 2020. A study was eligible if it included measurements of cognitive function, vision or hearing, and activities of daily living. Additionally, the data analyses must address how cognitive impairment and sensory loss are related to the performance of activities of daily living. RESULTS: The final review included 15 studies. Findings show an additive effect of cognitive impairment and sensory loss on the activities of daily living. Cognitive impairment or vision loss independently relates to the decline in activities of daily living. Hearing loss relates to the decline only when the loss is severe, or if the daily task is hearing - specific. DISCUSSION AND IMPLICATIONS: Older adults with coexisting sensory loss and cognitive impairment have the highest risk or prevalence of disability, comparing to cognitive impairment or sensory loss alone. This finding highlights the importance of developing interventions to reduce the risk of disability for older adults experiencing multiple impairments.