IU School of Nursing Works

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https://hdl.handle.net/1805/8325

Scholarship (articles, conference presentations, reports, posters and proceedings) by IU School of Nursing faculty, staff and students.

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Developing and testing a new theoretical model of pain in heart failure
(2024-11-16) Smith, Asa; Jung, Miyeon; Pressler, Susan
Introduction: An estimated 23-85% of adults with chronic heart failure (HF) experience comorbid chronic pain, yet no comprehensive theoretical models have been developed or tested that completely capture the salient variables which affect pain. The aim of this study was to construct a preliminary theoretical model of pain in HF and evaluate the associations between identified variables in the model with pain presence. Methods: In this cross-sectional study, baseline data were obtained from the Cognitive Intervention to Improve Memory in Heart Failure Patients study (MEMOIR-HF) (n = 235). The Biopsychosocial Model of Chronic Pain was adapted for an HF-specific population. The dependent variable was pain presence (yes/no), which was measured using the Health Utilities Index Mark-3 (HUI-3). Independent variables were identified for the model using previous literature and univariate analyses comparing patients with vs. without pain in MEMOIR-HF. Logistic regression was used to test for differences between patients with pain present and not present. Results: Demographics were 45.5% men, 54.5% women, 86.4% White, 13.6% Black, mean age 66.39 (SD 12.04) years. Of 235 patients, 159 (67.66%) reported pain on the HUI-3 items. The variables that were included following univariate analysis and literature review were age, self-reported race and gender, comorbid conditions, sleep disturbances, HF severity, B-type natriuretic peptide, brain-derived neurotrophic factor, body mass index, and depression. Patients with pain were more likely to have worse HF severity (NYHA Class II or III compared with Class I) (Class II: OR 5.09 [1.71 – 15.08], p = .003, Class III: 5.05 [1.73 – 14.71], p = .003), more severe depression (OR 1.14 [1.06 – 1.23], p = .001), and worsened daytime sleepiness (OR 0.90 [0.83 – 0.98], p = .017), see Table 1. Conclusions: We believe this study is one of the first to construct and test a preliminary comprehensive model of pain in HF. Complete characterization of pain in HF is needed before treatments can be improved. Future research is needed to explore variables that were not available in the MEMOIR-HF dataset. More robust pain measures are needed to adequately test all variables.
The All of Us Dataset with healthcare access/utilization
(2025-11-09) Smith, Asa
Healthcare-related social determinants of health are associated with pain severity among adults with comorbid heart failure and chronic pain
(2025-11-08) Smith, Asa B.; Knopf, Amelia; Webster-Dekker, Katelyn E.; Moore, Scott E.; Wierenga, Kelly L.
Introduction: Chronic pain worsens symptom burden, physical function, and quality of life in heart failure (HF). Social determinants of health (SDOH) can shape the trajectory of HF and other disease states. Healthcare-related SDOH may also be related to the severity of pain among people with HF, but these relationships are unexplored. The aims among adults with HF and chronic pain were to: 1) describe healthcare-related SDOH; 2) compare healthcare utilization by pain severity; and 3) examine the relationship between healthcare-related SDOH and pain severity. Methods: In this cross-sectional study, descriptive statistics and multiple linear regression were used to analyze data from 3,988 participants with HF and chronic pain enrolled in the All of Us Research Program. Pain severity was assessed using a 0-10 scale. Healthcare-related SDOH variables were insurance coverage, self-reported access barriers, and healthcare affordability. Healthcare utilization variables were the number of general provider visits, prescribing advanced practice clinician visits, and specialist visits in the past 12 months. Results: The sample was mean age 70.04 years, 58% female, and 69.8% White race. Over 98% of participants had health insurance. The most common self-reported access barrier, unaffordable service, and medication cost-saving behavior was “no transportation” (14.7%), “dental care” (19.7%), and “asking for lower cost prescriptions” (24.2%), respectively (see Figure 1). Most participants saw a provider 2-3 times over 12 months, but those with higher pain severity saw a general provider more frequently than other pain groups (see Figure 2). Participants with a higher number of self-reported access barriers (β = 0.221 ± 0.044, p < .001), and a higher number of unaffordable services (β = 0.165 ± 0.034, p < .001), experienced higher pain severity. In contrast, participants who adopted a higher number of medication cost-saving behaviors experienced significantly lower pain severity (β = -0.108 ± 0.040, p = .007). Participants who were younger, female sex, non-White race, had more comorbidities, a positive depression diagnosis, and lower reported fatigue, experienced significantly higher pain severity (see Table 1). Conclusions: Despite the high percentage of insured participants, there were notable access and affordability barriers, which were associated with pain severity. These barriers should be confirmed with targeted studies that directly examine pain-related services.
Development of a situation-specific biopsychosocial model of pain in heart failure
(Wolters Kluwer, 2025) Smith, Asa; Jung, Miyeon; White, Fletcher; Dorsey, Susan; Giordani, Bruno; Pressler, Susan
Theories of pain have been developed in several patient populations, but none currently exist for heart failure (HF) that include contributing factors and associated outcomes. We developed a situation-specific theory of pain in HF by adapting the biopsychosocial model of pain. Existing theoretical and empirical literature in HF samples was utilized to construct the new theory. Components, contributing factors, and associated outcomes of pain in HF are presented in the new theory. Areas in need of additional research are emphasized, and strengths and limitations are discussed. This theory could provide a foundation for future pain research initiatives in HF.
A Concept Analysis of the Perception of Diabetes Inevitability
(2023) Alwine, Jennifer S.; Trueblood Miller, Wendy R.
The complexities of pain in heart failure: locations, comorbid conditions, medications, subtypes, and limitations with activities
(Indiana University School of Nursing, 2025-03-28) Smith, Asa B.; Jung, Miyeon; Pressler, Susan J.
Therapeutic trust in complex trauma: a unique person – centered understanding
(Taylor & Francis, 2024) Chouliara, Zoë; Murray, Jennifer; Coleman, Ann Marie; Burke Draucker, Claire; Choi, Wai Man Anna; School of Nursing
We investigated the lived experience of therapeutic trust and its ruptures in working with clients with complex trauma presentations, a vulnerable and under-researched client group. A total of 13 clinicians and key informants, working in the field of complex trauma, were interviewed. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA) to identify recurrent themes. The Nature, Function, Components, Process, and Challenges of building and maintaining therapeutic trust were identified. Therapeutic trust was experienced as a mechanism for reducing threat, processing vulnerability, and enabling accurately symbolisation. Focusing on trust and its ruptures seems key in working with clients presenting with complex traumas and potentially other severe and/or complex presentations. The importance of trust-focused person-centred approaches for addressing key psychological challenges, increasing engagement, and addressing experiences of disengagement in complex trauma is stressed. The central role of trust in the therapeutic relationship as a catalyst of change brings person- centred models to the fore of psychotherapy for complex trauma, as well as severe and/or complex presentations. In a traumatogenic world, therapists will be increasingly called to work with more clients presenting with traumas. A person-centred understanding seems to hold a lot of promise. Strategies for actively facilitating trust – focused, practice are proposed.
Weight Variability, Weight Gain Goals, and Biopsychosocial Factors Among Pregnant Women
(Sage, 2024-01) Shieh, Carol; Ofner, Susan; School of Nursing
This study investigated the pattern of weight variability over 8 weeks and its associations with achieving weight gain goals and five biopsychosocial factors among pregnant women. We conducted a secondary analysis of 117 weeks of data from 16 pregnant women with a body mass index (BMI) ≥25. Weight variability was calculated from the difference of ending and beginning and maximum and minimum weights in a week and percent of each difference from baseline weight. Loess smoother, repeated measures model, and compound symmetric covariance matrix were used for analysis. The variability measure of maximum-minimum weight (overall mean: 2.1 ± 0.4 lbs.) was greater than the ending-beginning weight measure (overall mean: 0.7 ± 0.6 lbs.). Weight variability was negatively associated with achieving weight gain goals but not with biopsychosocial factors. Assessing weight variability is important during pregnancy so that preventive measures or lifestyle counseling can be instituted immediately to prevent excessive weight gain.
Description of an Audio-Based Paced Respiration Intervention for Vasomotor Symptoms
(IAMM, 2013) Burns, Debra S.; Drews, Michael R.; Carpenter, Janet S.; School of Nursing
Millions of women experience menopause-related hot flashes or flushes that may have a negative effect on their quality of life. Hormone therapy is an effective treatment, however, it may be contraindicated or unacceptable for some women based on previous health complications or an undesirable risk-benefit ratio. Side effects and the unacceptability of hormone therapy have created a need for behavioral interventions to reduce hot flashes. A variety of complex, multimodal behavioral, relaxation-based interventions have been studied with women (n = 88) and showed generally favorable results. However, currently extensive resource commitments reduce the translation of these interventions into standard care. Slow, deep breathing is a common component in most interventions and may be the active ingredient leading to reduced hot flashes. This article describes the content of an audio-based program designed to teach paced breathing to reduce hot flashes. Intervention content was based on skills training theory and music entrainment. The audio intervention provides an efficient way to deliver a breathing intervention that may be beneficial to other clinical populations.
The Experience of Peripheral Neuropathy Symptoms in Breast Cancer Survivors With Diabetes
(Wolters Kluwer, 2024-07) Storey, Susan; Draucker, Claire; Haunert, Laura; Von Ah, Diane; School of Nursing
Background Diabetes (type 2) is a risk factor for developing peripheral neuropathy (PN) symptoms in breast cancer survivors (BCS). Because PN symptoms are associated with deficits in physical functioning and quality of life, more information is needed about the effects of PN symptoms on the lives of BCS with diabetes. Objective The aim of this study was to describe the experiences of PN among BCS with diabetes from their own perspectives. Interventions/Methods This substudy is part of a larger investigation examining factors associated with cancer-related cognitive impairment in cancer survivors. Female early-stage (stage I–III) BCS with diabetes and PN symptoms were eligible to participate. A qualitative descriptive approach using purposive sampling and semistructured interviews was used. Participant narratives were summarized using standard content analytic techniques. Results Eleven BCS with diabetes and PN symptoms were interviewed. Participants described PN symptoms that were varied, were often persistent, and had troublesome effects on their physical functioning and quality of life. Participants used a variety of self-management strategies and prescription and over-the-counter medications to manage their PN symptoms. Some said that having both cancer and diabetes exacerbated the PN symptoms and complicated symptom management. Conclusion Peripheral neuropathy symptoms can have a profound effect on the lives of BCS with diabetes and should be addressed by healthcare providers.

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