Browsing by Author "Welch, Janet L."
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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 Development and Testing of the Colonoscopy Embarrassment Scale(2010-01-26T20:06:42Z) Mitchell, Kimberly Ann; Rawl, Susan M.; Champion, Victoria; Jeffries, Pamela R.; Welch, Janet L.Colorectal cancer (CRC), the third leading cause of cancer-related death in the U.S., could largely be prevented if more people had polyps removed via colonoscopies. Embarrassment has been identified as one important barrier to colonoscopy, but little is known about embarrassment in this context. Further, there is no instrument available to measure this construct. Therefore, the purpose of this study was to develop a reliable and valid instrument to measure colonoscopy-related embarrassment. The study aims were to: 1) estimate reliability and validity of a new instrument, the Colonoscopy Embarrassment Scale (CES); 2) examine relationships among demographic/personal characteristics, health beliefs, and CES scores; 3) examine relationships among demographic/personal characteristics, physician recommendation, health beliefs, and colonoscopy compliance; and 4) evaluate participants’ perceptions of aspects of having a colonoscopy that are most embarrassing and their suggestions for reducing embarrassment. The Health Belief Model and Transtheoretical Model of Change provided theoretical support for this study. Participants were HMO members aged 50-65 years (n=234). Using a cross-sectional, descriptive research design, data were collected using a mailed survey. The response rate was 56%. Data were analyzed using independent samples t-tests, correlations, Chi Square, and regression. Results showed that the six-item CES had internal consistency (Cronbach’s alpha of .89) and construct validity. Lower income, higher BMI, lower CRC knowledge, higher barriers, and lower self-efficacy were related to higher CES scores (or more embarrassment). Higher CRC knowledge, lower barriers, higher self-efficacy, and a physician recommendation for the test were related to higher compliance with colonoscopy. Lower barriers, higher self-efficacy, and a physician recommendation were predictive of compliance with colonoscopy. In conclusion, embarrassment is a significant barrier to colonoscopy, yet there are steps that can be taken to reduce embarrassment such as increasing privacy and limiting bodily exposure. The CES is a tool that can be used to measure colonoscopy-related embarrassment and the results could be used in developing further interventions to reduce embarrassment, leading to increased colonoscopies and lower mortality.Item THE EFFECT OF CURRICULAR SEQUENCING OF HUMAN PATIENT SIMULATION LEARNING EXPERIENCES ON STUDENTS’ SELF-PERCEPTIONS OF CLINICAL REASONING ABILITIES(2011-11-18) Jensen, Rebecca Sue; Ebright, Patricia; Pesut, Daniel J.; Fisher, Mary L., Ph.D.; Welch, Janet L.It is unknown whether timing of human patient simulation (HPS) in a semester, demographic (age, gender, and ethnicity), and situational (type of program and previous baccalaureate degree and experience in healthcare) variables affects students’ perceptions of their clinical reasoning abilities. Nursing students were divided into two groups, mid and end of semester HPS experiences. Students’ perceptions of clinical reasoning abilities were measured at Baseline (beginning of semester) and Time 2 (end of semester), along with demographic and situational variables. Dependent variable was Difference scores where Baseline scores were subtracted from Time 2 scores to reveal changes in students’ perceptions of clinical reasoning. Students who were older and had previous healthcare experience had higher scores, as well as students in the AS program, indicating larger changes in students’ perceptions of clinical reasoning abilities from Baseline to Time 2. Timing of HPS, mid or end of semester, had no effect on Difference scores, and thus students’ perceptions of clinical reasoning abilities.Item Formative evaluation of a mobile liquid portion size estimation interface for people with varying literacy skills(Springer Berlin Heidelberg, 2013-12) Chaudry, Beenish Moalla; Connelly, Kay; Siek, Katie A.; Welch, Janet L.; IU School of NursingChronically ill people, especially those with low literacy skills, often have difficulty estimating portion sizes of liquids to help them stay within their recommended fluid limits. There is a plethora of mobile applications that can help people monitor their nutritional intake but unfortunately these applications require the user to have high literacy and numeracy skills for portion size recording. In this paper, we present two studies in which the low- and the high-fidelity versions of a portion size estimation interface, designed using the cognitive strategies adults employ for portion size estimation during diet recall studies, was evaluated by a chronically ill population with varying literacy skills. The low fidelity interface was evaluated by ten patients who were all able to accurately estimate portion sizes of various liquids with the interface. Eighteen participants did an in situ evaluation of the high-fidelity version incorporated in a diet and fluid monitoring mobile application for 6 weeks. Although the accuracy of the estimation cannot be confirmed in the second study but the participants who actively interacted with the interface showed better health outcomes by the end of the study. Based on these findings, we provide recommendations for designing the next iteration of an accurate and low literacy- accessible liquid portion size estimation mobile interface.Item Illness Representation and Medication Adherence of Patients with Chronic Kidney Disease(2012-03-16) McManus, M. Sue; Welch, Janet L.; Rawl, Susan M.; Sloan, Rebecca S.; Halstead, Judith A.Chronic kidney disease (CKD) places a high personal and economic burden globally on individuals, families, and society. Although kidney protective medications slow the progression of CKD to end stage kidney disease, adherence to these medications is inadequate. The primary purposes of this study are to: 1) describe the illness and treatment beliefs of CKD patients in stage 3 guided by the Common Sense M model (CSM); and 2) examine the relationship of those beliefs with adherence to renal protective medications, ACE-I. Secondary purposes of this study include determining adherence levels of ACE-I among patients with CKD stage 3; examining relationships between individual and clinical characteristics with patient beliefs and medication adherence with ACE-I; and examining the relationship between the Medication Adherence Report Scale (MARS) and the Medication Possession Ratio (MPR). Using a descriptive cross-sectional design, a convenience sample of 92 individuals with Stage 3 CKD was obtained from a Midwestern VA medical center. Data were collected through self-administered mailed surveys and medical record reviews. Data analyses were performed using descriptive statistics, correlation, t-tests and ANOVA. Seventeen symptoms experienced were perceived as related to CKD by at least one respondent with most reporting legs/feet swelling (n=31). Top perceived cause of CKD was aging (60%). Revised Illness Perception Questionnaire (IPQ-R) items were scored from 1 to 5 with higher scores indicating perceptions of higher personal and treatment control of chronic, cyclical illness with serious consequences and negative emotional reactions. In this study, the CKD timeline was perceived as a long-term chronic rather than short-term acute condition (M = 3.8), with minimal cyclical exacerbations (M = 2.7), and moderate severity of consequences (M = 3.1). Respondents perceived having both, but more personal control than treatment control of CKD (M = 3.5 v 3.2). Participants did not perceive CKD as related to a great negative emotional response (M = 2.8). Illness Representations were not found to be significantly correlated with self-reported medication adherence. Medication adherence levels by self-report (M = 4.8 [5 = perfect adherence]) and pharmacy refill records (73% had perfect refill ratio of 1:1) reveal highly adherent levels among this sample.Item Knowledge and Awareness Among Patients with Chronic Kidney Disease Stage 3(American Nephrology Nurses Association, 2016) Welch, Janet L.; Bartlett Ellis, Rebecca J.; Perkins, Susan M.; Johnson, Cynthia S.; Zimmerman, Lani M.; Russell, Cynthia L.; Richards, Christine; Guise, David M.; Decker, Brian S.; School of NursingKnowledge is a prerequisite for changing behavior, and is useful for improving outcomes and reducing mortality rates in patients diagnosed with chronic kidney disease (CKD). The purpose of this article is to describe baseline CKD knowledge and awareness obtained as part of a larger study testing the feasibility of a self-management intervention. Thirty patients were recruited who had CKD Stage 3 with coexisting diabetes and hypertension. Fifty-four percent of the sample were unaware of their CKD diagnosis. Participants had a moderate amount of CKD knowledge. This study suggests the need to increase knowledge in patients with CKD Stage 3 to aid in slowing disease progression.Item Medication-taking behaviours in chronic kidney disease with multiple chronic conditions: a meta-ethnographic synthesis of qualitative studies(Wiley, 2017-03) Bartlett Ellis, Rebecca J.; Welch, Janet L.; IU School of NursingAims and objectives To identify behaviours associated with taking medications and medication adherence reported in qualitative studies of adults with chronic kidney disease and coexisting multiple chronic conditions. Background To inform medication adherence interventions, information is needed to clarify the nature of the relationships between behaviours that support medication-taking and medication adherence in multiple chronic conditions. Design Meta-ethnographic review and synthesis. Methods CINAHL Complete, MEDLINE and PsycINFO databases were searched. Five qualitative studies met the inclusion criteria. A meta-ethnographic approach was used for synthesis. Medication-taking behaviours were abstracted from study findings and synthesised according to the contexts in which they occur and interpreted within a new developing framework named the Medication-taking Across the Care Continuum and Adherence-related Outcomes. Results Twenty categories of medication-taking behaviours occurred in three main contexts: (1) patient–provider clinical encounters, (2) pharmacy encounters and (3) day-to-day management. These behaviours are distinctly different, multilevel and interrelated. Together they represent a process occurring across a continuum. Conclusions Future medication adherence research should consider using a multilevel ecological view of medication management. Clinical practice and policy development can benefit from further understanding socio-contextual behaviours that occur across the continuum. Nurses should have greater presence in chronic disease management and be positioned to support the day-to-day home management of patients' medications.Item Patient Activation with Knowledge, Self-Management, and Confidence in Chronic Kidney Disease(Wiley, 2016-03) Johnson, Michelle L.; Zimmerman, Lani; Welch, Janet L.; Hertzog, Melody; Pozehl, Bunny; Plumb, Troy; IU School of NursingBackground Chronic kidney disease is a growing health problem on a global scale. The increasing prevalence of chronic kidney disease presents an urgent need to better understand the knowledge, confidence and engagement in self-managing the disease. Objectives This study examined group differences in patient activation and health-related quality of life, knowledge, self-management and confidence with managing chronic disease across all five stages of chronic kidney disease. Design The study employed a descriptive correlational design. Settings Participants were recruited from five primary care, three nephrology clinics and one dialysis centre in two Midwestern cities in the United States. Participants The convenience sample included 85 adults with hypertension, diabetes mellitus and chronic kidney disease, including kidney failure, who spoke English. Measurements Seven measurements were used to collect data via telephone interviews with participants not receiving haemodialysis, and face-to-face interviews with those receiving haemodialysis at the beginning of their treatment session. Results Analyses indicated that half the participants were female (50.58%), the mean age was 63.21 years (SD = 13.11), and participants with chronic kidney disease stage 3 were the most activated. Post hoc differences were significant in patient activation and blood pressure self-management and anxiety across chronic kidney disease stages, excluding stage 5. Conclusion Engaging patients in the self-management of their health care and enhancing patients’ ability to self-manage their blood pressure may work to preserve kidney health. Healthcare providers should collaborate with patients to develop strategies that will maintain patients’ health-related quality of life, like reducing anxiety as kidney disease progress.Item Self-management interventions in stages 1 to 4 chronic kidney disease: an integrative review(SAGE, 2015-05) Welch, Janet L.; Johnson, Michelle; Zimmerman, Lani; Russell, Cynthia L.; Perkins, Susan M.; Decker, Brian S.; IU School of NursingThe prevalence, effect on health outcomes, and economic impact of chronic kidney disease (CKD) have created interest in self-management interventions to help slow disease progression to kidney failure. Seven studies were reviewed to identify knowledge gaps and future directions for research. All studies were published between 2010 and 2013; no investigations were conducted in the United States. Knowledge gaps included the focus on medical self-management tasks with no attention to role or emotional tasks, lack of family involvement during intervention delivery, and an inability to form conclusions about the efficacy of interventions because methodological rigor was insufficient. Educational content varied across studies. Strategies to improve self-management skills and enhance self-efficacy varied and were limited in scope. Further development and testing of theory-based interventions are warranted. There is a critical need for future research using well-designed trials with appropriately powered sample sizes, well-tested instruments, and clear and consistent reporting of results.Item Skills Included in Self-Management Interventions to Help People with Chronic Kidney Disease(Office of the Vice Chancellor for Research, 2014-04-11) Drenzyk, Debbie E.; Gardner, Marcy R.; Welch, Janet L.Slowing the progression of chronic kidney disease (CKD) is a major goal of medical therapy and requires significant and complex self-management behaviors from patients. Similar to other chronic conditions, patients must have the knowledge, confidence, and skills to self-manage the disease in daily living. The core self-management skills of problem-solving, decision making, resource utilization, patient-provider partnerships, action planning, and self-tailoring will help patient perform key behaviors associated with slowed progression. These key behaviors include the avoidance of nonsteroidal anti-inflammatory drugs (NSAIDS), diet modifications, glycemic control, regular exercise, systolic blood pressure control, tobacco avoidance, and adherence to angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) medications. The purpose of this literature review was to review the components of tested CKD self-management interventions to identify the self-management skills that were included in the published studies and how the interventions were delivered. A search for literature was performed using multiple databases. Articles were selected for review if they were written in English, included adults 18 years of age who had Stage 1-4 CKD, and tested a self-management intervention using a quasiexperimental or experimental design. A total of eight research articles met the inclusion criteria. Action planning, problem-solving and enhancing patient-provider partnerships were included in some interventions; there was no evidence of decision-making, resource utilization, or self-tailoring. All of the interventions were delivered using face-to-face educational programs and none used information technology. Data from this review provides important information for designing future interventions that will improve CKD self-management programs. In addition, findings suggest additional methods are needed when delivering interventions so programs are readily available to underserved areas.