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Biomedical subjects

Janet L Welch

Publications and source records attributed to Janet L Welch.

11 recordsLinked to original sources
PubMed2006

Benefits of and barriers to dietary sodium adherence.

Failure to limit dietary sodium leads to thirst, large fluid weight gain, and poor outcomes in patients receiving hemodialysis. Perceived benefits and barriers may influence adherence; however, tools measuring these relationships are not available. This study's purpose, based on the health belief model, was to evaluate the reliability and validity of the Beliefs about Dietary Compliance Scale (BDCS), describe perceived benefits and barriers over time, and identify individual benefits and barriers that may be amenable to tailored interventions. A convenience sample of 229 completed the BDCS at baseline. One week after baseline, 52 participants completed the BDCS to assess test-retest reliability. Four months after baseline, 187 participants (81%) remained. Cronbach's alphas for the scale ranged from .66 to .81. One-week test-retest reliabilities ranged from .68 to .86. Factor structure was supported by factor analysis. Scores remained stable over time. Barriers to dietary sodium limitations were common and more in need of intervention.

Adolescent↗
PubMed2005

Psycho-educational strategies to promote fluid adherence in adult hemodialysis patients: a review of intervention studies.

BACKGROUND: We reviewed psycho-educational intervention studies that were designed to reduce interdialytic weight gain (IDWG) in adult hemodialysis patients. Our goals were to critique research methods, describe the effectiveness of tested interventions, and make recommendations for future research. METHODS: Medline, PsychInfo, and the Cumulative Index to Nursing and Applied Health (CINAHL) databases were searched to identify empirical work. Each study was evaluated in terms of sample, design, theoretical framework, intervention delivery, and outcome. RESULTS: Nine studies were reviewed. Self-monitoring appears to be a promising strategy to be considered to reduce IDWG. Theory was not usually used to guide interventions, designs generally had control groups, interventions were delivered individually, more than one intervention was delivered at a time, the duration of the intervention varied greatly, there was no long-term follow-up, IDWG was the only outcome, and IDWG was operationalized in different ways. CONCLUSIONS: Theoretical models and methodological rigor are needed to guide future research. Specific recommendations on design, measurement, and conceptual issues are offered to enhance the effectiveness of future research.

Adult↗
PubMed2004

Cognitive status in hemodialysis as a function of fluid adherence.

Previous work has shown that dialysis improves cognitive functioning in hemodialysis patients, perhaps due to improvements in anemia among these patients. Such improvements in cognitive performance may lead to better levels of self-care and adherence with treatment. This study examined the relationship between fluid adherence and cognitive functioning in patients receiving hemodialysis. One hundred forty-seven patients were assessed with a brief screening instrument, the Cognistat, to determine their current level of functioning during the first hour of hemodialysis. Fluid nonadherence was operationalized as interdialytic weight gain above 1 kg/day. Rates of impairment on the Cognistat subscale ranged from 2.7% (orientation) to 54% (memory) in this sample. Roughly 68% of the sample was nonadherent during the course of treatment. Results found no differences in mean levels of cognitive performance between those who were adherent and those who were not and only modest relationships of measures of anemia to certain aspects of cognitive performance. For the hemodialysis patient to benefit from self-care education, the patient must be able to understand, remember, reason, and use cognitive processes to modify behavior. These results suggest that more in-depth assessment of cognitive performance may be needed. In addition, this assessment may need to be conducted on a day when treatment is not received.

Cognition Disorders↗
PubMed2003

Differences in perceptions by stage of fluid adherence.

OBJECTIVE: The purpose of this study was to determine in a group of hemodialysis patients whether perceptions of barriers to and benefits of adherence to fluid limitations, perceived seriousness of and susceptibility to the consequences of nonadherence, self-efficacy, and thirst differed by stage of fluid adherence. DESIGN: Cross-sectional descriptive design. SETTING: There were 147 participants from rural, suburban, and urban outpatient hemodialysis units. RESULTS: Significant differences were found in perceived benefits, barriers, seriousness, susceptibility, and thirst intensity by stage of fluid adherence. There were no significant differences in self-efficacy by stage of fluid adherence. CONCLUSION: Stage of fluid adherence may be important to consider when designing interventions to reduce fluid intake.

Adult↗
PubMed2002

A cost-effectiveness worksheet for patient-education programs.

This article describes the development, implementation, and evaluation of a worksheet used by nursing faculty in a graduate clinical nurse specialist course to assist students in learning to estimate the cost-effectiveness of patient-education programs.1 The worksheet was found to be a satisfactory method of facilitating student learning and could also be used in the service arena to evaluate the cost aspects of patient-education programs.

Cost-Benefit Analysis↗
PubMed2002

Development of the thirst distress scale.

This article describes the development of a 6-item instrument that measures thirst distress. Items were developed following open-ended interviews with 10 subjects, a literature review, and development of a conceptual definition of thirst. A panel of experts established content validity. A convenience sample (N = 247) of adults receiving outpatient hemodialysis completed the scale. A panel of experts was used to assess content validity. Item analysis was used to select unrelated or redundant items for deletion. Cronbach's alpha was .78. Construct validity was supported by confirmatory and exploratory factor analysis. Positive relationships between thirst distress and, respectively, thirst intensity and interdialytic weight gain provided additional evidence of construct validity. Overall, these preliminary data indicate that the thirst distress scale has sufficient reliability and validity for use in clinical studies.

Adult↗
PubMedDate not supplied

Symptom experiences of chronically constipated women with pelvic floor disorders.

PURPOSE: Chronic constipation is a frequent and bothersome problem in women with pelvic floor disorders, and standard treatment protocols are often ineffective. The purposes of this study were to describe the constipation symptom experience, perceived effectiveness of symptom-management strategies, and the lifestyle limitations associated with constipation symptoms among women with pelvic floor disorders. DESIGN: A cross-sectional descriptive design was used. SETTING: Participants were recruited from a tertiary-level outpatient urogynecology center. SAMPLE: Thirty women with pelvic floor disorders completed a self-administered instrument at the time of their clinic appointment. METHODS: The instrument included questions about the distress, frequency, intensity, and occurrence of constipation symptoms. In addition, the effectiveness of symptom-management strategies used to treat constipation and the lifestyle limitations associated with constipation were assessed. FINDINGS: The symptom experience of chronic constipation in these women included multiple distressing and uncomfortable symptoms that resulted in mild lifestyle limitations. Although self-management strategies were perceived to have limited effectiveness, the most effective strategies used by the women to manage constipation included use of laxatives, using their hand in or near the vagina or rectum to expel stool, and using an enema. CONCLUSIONS: More effective interventions are needed to promote satisfactory symptom management of chronic constipation for women with pelvic floor disorders. Further assessment of outcomes, including comfort and depression, may be warranted. IMPLICATIONS FOR PRACTICE: A more thorough assessment of constipation symptoms in this population is recommended. A combination of symptom-management strategies may be needed to relieve the multiple symptoms associated with constipation.

Adult↗
PubMedDate not supplied

Nutrition in chronic heart failure with coexisting chronic kidney disease.

BACKGROUND AND RESEARCH OBJECTIVES: Patients with heart failure (HF) may be predisposed to malnutrition. Little is known about the nutritional status of patients with HF, particularly patients who have coexisting major medical conditions such as chronic kidney disease. The purposes of this study were to (1) describe the nutritional status of 211 patients with chronic HF, (2) examine relationships between nutrition variables and health-related quality of life, and (3) evaluate the nutritional status of the subset of HF patients with coexisting chronic kidney disease. SUBJECTS AND METHODS: The sample included 211 patients with chronic HF recruited for a larger study about health-related quality of life. Clinical data were retrieved retrospectively from the computerized medical records system at the study site. RESULTS AND CONCLUSIONS: Mean body mass index of the 122 patients for which height was available was 31.4, and no differences in body mass index were noted among patients with varying New York Heart Association class functional status. Evaluation of the mean laboratory values indicated that patients had abnormal elevations of serum glucose, hemoglobin A1C, creatinine, and low-density lipoprotein cholesterol. Higher hemoglobin A1C levels were significantly correlated with poorer health-related quality-of-life scores, although the magnitude of the correlations was modest. Estimated glomerular filtration rate indicated that 54 (27%) of the HF patients likely had coexisting chronic kidney disease, and these patients had significantly lower serum albumin and worsening anemia. The results indicate the need for future prospective studies that incorporate evaluation of nutritional status and the ways in which coexisting chronic kidney disease influences outcomes.

Adult↗
PubMedDate not supplied

Use of electronic self-monitoring for food and fluid intake: A pilot study.

In this small pilot study, the authors examined the use of a personal digital assistant (PDA) to electronically self-monitor the dietary and fluid intake of individuals receiving hemodialysis. The purpose of this study was to describe intake patterns of fluid, sodium, potassium, phosphorus, protein, and calories over a 3-month period as recorded using a PDA. Mean weekly intake values were plotted on line graphs to examine trends of intake. The patients' mean weekly intakes of sodium, potassium, phosphorus, and fluid were dynamic and fluctuating. Protein and caloric intakes were significantly below the recommendations of the K/DOQI guidelines. Standard methods to assess intake may not adequately capture intake patterns on a daily basis.

Aged↗
PubMedDate not supplied

Patterns of interdialytic weight gain during the first year of hemodialysis.

This retrospective study describes patterns of interdialytic weight gain (IWG) over the first year of hemodialysis in 27 individuals. IWG increased over the first 12 weeks and appeared to reverse after 12 weeks, increasing again after 32 weeks. Interventions may need to occur after the individual has been receiving treatment for 12 weeks; booster interventions may be indicated after 32 weeks. Variability in the two measures used (mean daily interdialytic weight gain and mean daily percent above dry weight) suggests a need for further study.

Adult↗