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Biomedical subjects

L K Wright

Publications and source records attributed to L K Wright.

17 recordsLinked to original sources
PubMed2000

The role of a clinical outcome research evaluator. A graduate nursing student's experience.

Outcome evaluation research is a relatively new paradigm that allows those in nursing to explain the impact of an intervention. The term efficacy is used when an intervention is evaluated as part of a controlled research study, while effectiveness denotes outcome evaluation of uncontrolled interventions in diverse settings. This article describes a graduate nursing student's supervised research experience that contributed to evaluating the efficacy of an intervention consisting of counseling caregivers of elders with dementia via telecommunications. The student's preparation for the role of research evaluator included acquisition of conceptual knowledge about evaluation research, interviewing techniques, and analytical skills to interpret evaluation data. Conceptual knowledge focused on the application of the Donabedian Structure. Process, Outcome Model and issues such as stakeholder, vested interest, and confidentiality. Data collection interviews involved the use of open-ended questions (qualitative) and administration of a structured questionnaire (quantitative). Analysis of qualitative data required identification of positive and negative themes; item responses on the structured questionnaire were compiled as percentages. Findings from the evaluation were used to improve the design of an ongoing intervention study.

Caregivers↗
PubMed1999

Emotional and physical health of spouse caregivers of persons with Alzheimer's disease and stroke.

Providing care for a cognitively impaired spouse can adversely affect caregivers' health. It is not known how early in the caregiver's 'career' emotional and physical health deteriorates. The progressive deterioration associated with Alzheimer's disease (AD) may have different effects on caregivers' health when compared with the potential recovery following a stroke. An exploratory study was conducted with 42 couples, equally divided among early phase AD, ischaemic stroke after hospital discharge, and well controls. Couples were evaluated at baseline (time 1), 6 months (time 2) and 1 year (time 3). At time 1, depression was significantly higher in AD and stroke caregivers when compared to controls. Over time, depression increased significantly for AD caregivers with 21% evidencing moderate to severe depression at time 1 and 50% at time 3. For stroke caregivers there was a significant interaction effect with race: white stroke caregivers' depression increased over time while African American stroke caregivers' depression decreased. Physical health was not significantly different for the three groups and remained stable over time. Cognitive and functional impairment levels of care recipients were significantly related to stroke caregivers' but not AD caregivers' depression. Long-term counselling and support to family caregivers is advocated.

Aged↗
PubMed1998

Telecommunication interventions for caregivers of elders with dementia.

Caregiver Interventions via Telecommunications (CIT) is designed for family caregivers of elders with dementia. Building on Riegel's dialectical theory of human development, the authors argue that psychotherapeutic interventions, made highly accessible by telecommunication technology, assist caregivers to achieve positive developmental outcomes. Specific components of CIT are described, and an outline for a structured protocol is provided. Advantages, disadvantages, and future directions of telecommunications therapy are discussed.

Aged↗
PubMed1995

Human development in the context of aging and chronic illness: the role of attachment in Alzheimer's disease and stroke.

Does chronic illness in older people provide potentials for human development? To date, this question has not been adequately addressed by dynamic theorists of human development. In this article, two illness trajectories, Alzheimer's disease and stroke, are examined to illustrate emerging changes in human development over each course of illness and the increasing importance of attachment behavior among ill elders and their family members. It is argued that the phenomenon of attachment links ailing older people to their environment, and that attachment is vital if human development is to continue.

Aged↗
PubMed1994

Alzheimer's disease afflicted spouses who remain at home: can human dialectics explain the findings?

When one spouse has Alzheimer's disease (AD), marital interactions tend to decline. Findings from this study suggest that level of spousal interactions influence longitudinal outcomes for afflicted spouses. Thirty AD spouses and their spouse caregivers were assessed at baseline (time 1) and two years later (time 2). Continued in-home care at time 2 is predicted by high levels of positive spousal interactions, high caregiver commitment, good caregiver health, and shorter time as caregiver (all assessed at time 1). The same variables but in an inverse relationship predict which AD spouses are deceased at time 2. Nursing home placement is predicted by AD spouses' higher educational level, unhappy marital relationships, and low caregiver commitment. Afflicted spouses' cognitive and functional impairment levels, their physical health and depression do not predict outcomes. A theoretical explanation is developed drawing on Riegel's dialectical theory of human development and Bowlby's attachment theory. It is suggested that interactions between spouses are crucial for afflicted spouses' survival.

Activities of Daily Living↗
PubMed1991

The impact of Alzheimer's disease on the marital relationship.

Caregiver-Alzheimer's afflicted spouse dyads were compared with healthy married couples. The former dyads were incongruent in their perception of tension and agreement over sexual issues, and caregivers differed significantly from well-group spouses on companionship and total marital quality. Only 27% of the Alzheimer's couples versus 82% of the well couples were still sexually active. High sexual activity occurred in 14% (n = 4) of male afflicted spouses (50% of sexually active couples), and of these, two were age less than or equal to 60. High sexual activity was problematic to three-fourths of the female caregiver spouses. Caregivers evidenced adaptation and control; afflicted spouses tended to deny problems and had distorted perceptions of interactions with their caregiver spouses.

Adaptation, Psychological↗
PubMed1990

Mental health in older spouses: the dynamic interplay of resources, depression, quality of the marital relationship, and social participation.

This study demonstrates a conceptual linkage between exchange theory and psychoanalytic theory of depression. The effects of diminished resources and the dynamic relationships between depression, quality of the marital relationship, and social participation were investigated with a sample of 229 community residing, married older people (Duke Longitudinal Study) using a combined structural and measurement model with linear structural relations (LISREL) analysis. Findings are that some resources have direct effects on depression, marital quality, and social participation. However, it is through the pathway of depressive moods that ill health, retirement, and stress have their negative effects on the marital relationship. Depressive moods do affect social participation, but psychosomatic symptoms of depression do not affect the amount of social participation nor the marital relationship. Recognizing depressive moods as intervening variables is important because older people tend to deny feeling depressed. Without a conceptual linkage of exchange and depression theories, this pathway would not have been identified.

Aged↗
PubMed1990

A model to facilitate interactive planning.

The IPEM has helped stakeholders in a very complex tertiary medical center to understand the importance of interactive planning. The need to do so was highlighted by nursing demand and shortage issues. Deliberate efforts to refine and to restructure patient care within a hospital necessitates multidisciplinary planning and problem solving, collaborative nurse/physician relationships, and sound recruitment/retention policies. The experience at one hospital shows how nurse executives can take ownership of issues that help to reduce nursing supply and demand problems. Restructuring of patient care is one method of addressing demand; supply can be addressed locally by collaborative relationships with schools of nursing to increase students' access to education. Enhancing professional nursing practice is the responsibility of nursing service executives as well as educators. Yet, ultimately, it is the hospital's professional environment and reward system that influences nurses' choice of practice setting.

Humans↗
PubMed1986

A proposal for tracking health care for the homeless.

The number of homeless in the nation has increased rapidly during the first half of this decade. These two million homeless individuals are at high risk for health problems since they lack the essentials to remain healthy. Several large cities have developed and implemented health care programs to alleviate the problem of the homeless in America. However, most of these programs have been instigated solely by health care providers who have differing goals, values, and beliefs about health care than those they purport to serve. These differing perspectives give rise to an array of health care utilization/accessibility problems including coordination and continuity of care. To address some of these problems of coordination, a Tool for Referral Assessment of Continuity (TRAC) has been developed for assisting a complex health care system in the referral and tracking of homeless clients. A description of the TRAC is included here.

Delivery of Health Care↗
PubMed1986

Screening to detect asymptomatic shedding of herpes simplex virus (HSV) in women with recurrent genital HSV infection.

To investigate the asymptomatic shedding of herpes simplex virus (HSV) from women with recurrent genital herpes infection, and to assess whether inapparent shedding could occur, eight such women were examined thrice weekly for one month. At each visit colposcopy was performed and multiple sites sampled for HSV. During the study four women had no recurrence of HSV infection, but four had at least one positive viral culture. One of these patients was asymptomatically shedding HSV on nine of her 11 clinic visits. Two episodes of urethral shedding were detected. In this group of patients the presence of inguinal lymphadenopathy was appreciably associated with the isolation of HSV from the urogenital tract.

Adult↗
PubMedDate not supplied

Continuum of care for Alzheimer's disease: a nurse education and counseling program.

This study evaluated a one year long course education and counseling program with 93 family caregivers of elders afflicted with Alzheimer's disease. The elders had received treatment for agitation in an inpatient setting and were subsequently discharged to the caregivers' home. Caregivers were randomly assigned to an experimental group (n = 68) and a control group (n = 25). Baseline assessments (Time 0) were conducted while the elder was an inpatient. Postdischarge interventions and assessments were conducted at 2 weeks, 6 weeks, 12 weeks, and 6 and 12 months (Times 1-5 respectively). There were no significant treatment effects for care recipient agitation, caregiver stress, depression, and physical health, and no significant differences between groups in rates of institutionalization for afflicted elders. Longitudinal data, however, revealed several important trends. Afflicted elders' agitation rose steadily for control group subjects at Times 3 through 5 but declined for experimental group subjects. Caregiver depression increased for control group subjects at Time 5, but declined for experimental group subjects. Caregiver physical health declined for control group subjects at Times 4 and 5 but was maintained for experimental group subjects. A significantly higher number of afflicted elders were still at home among experimental group subjects at the end of the one year study. The difficulties in demonstrating efficacy of interventions with family caregivers of Alzheimer's disease are discussed. Finally, the issue of data collection being perceived as support by control group subjects is evaluated.

Adult↗
PubMedDate not supplied

Moderating and mediating effects in causal models.

This article explains causal relationships in conceptual models of mental health phenomena. Direct, moderating, mediating, and reciprocal effects among variables are defined, appropriate statistical analyses are described, and the correct interpretations of moderating versus mediating effects are discussed. Examples are provided that will help the reader to distinguish between moderating and mediating effects.

Adaptation, Psychological↗
PubMedDate not supplied

Racial differences in health status and health behaviors of older adults.

BACKGROUND: Little is known about racial differences in health status and health behaviors of older adults, especially among the oldest old. OBJECTIVES: To investigate racial differences in health status and health behaviors of African American and Caucasian older adults and to identify factors that influence health behaviors of older adults. METHOD: A descriptive comparative study using data from the Georgia Centenarian Study was conducted. The subjects were 248 older adults (181 Caucasians and 67 African Americans) ranging in age from 60 to 107 years. Demographic characteristics, health status, and four health behaviors were assessed. RESULTS: African Americans had significantly lower mental health (p < .001) and poorer self-perceived health (p < .01) than did their Caucasian counterparts; however, when covaried with education and income, racial differences in self-perceived health were eliminated, and differences in mental health decreased but remained significant (p < .05). Using univariate analyses, only two health behaviors, physical activity and eating breakfast regularly, showed significant racial differences. Relatively few older adults participated in leisure-time physical activity. Logistic regression analyses indicated that race was not significantly related to any health behaviors. Age, gender, and physical health status were most frequently related to health behaviors. CONCLUSION: The findings indicated no robust racial differences in health status and health behaviors, especially when education and income were controlled. More research is recommended to clarify the factors that explain health behaviors of older adults.

Activities of Daily Living↗