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Biomedical subjects

Patricia Liehr

Publications and source records attributed to Patricia Liehr.

14 recordsLinked to original sources
PubMed2006

Adding story-centered care to standard lifestyle intervention for people with Stage 1 hypertension.

This study examined the blood pressure (BP)-lowering effect of adding story-centered care (i.e., carefully attending to another's narrative) to standard lifestyle intervention (i.e., exercise training and nutrition counseling) for people with Stage 1 hypertension. The subjects (N = 24), who were university and hospital employees, were unmedicated and received standard lifestyle intervention; half were randomly assigned to story-centered care. Their 24-hour BP was measured four times at 8-week intervals, twice before and twice after the intervention. Subjects who received story-centered care had greater decreases (p < .05) in awake systolic BP over the 6-month study period. Neither systolic nor diastolic sleep BP was significantly affected. Story-centered care showed promise for contributing to the BP-lowering effect of lifestyle intervention. Approaches for integrating story-centered care into the treatment of people with hypertension are challenging but warrant further attention.

Adult↗
PubMed2006

National evaluation of healthcare provider attitudes toward organ donation after cardiac death.

OBJECTIVE: Organ donation after cardiac death will save lives by increasing the number of transplantable organs. But many healthcare providers are reluctant to participate when the withdrawal of intensive care leads to organ donation. Prior surveys indicate ethical concerns as a barrier to the practice of organ donation after cardiac death, but the specific issues that characterize these concerns are unknown. We thus aimed to identify what barriers healthcare providers perceive. DESIGN: We conducted a qualitative analysis of focus group transcripts to identify issues of broad importance. SETTING: Healthcare setting. PARTICIPANTS: Participants included 141 healthcare providers representing critical care and perioperative nurses, transplant surgeons, medical examiners, organ procurement personnel, neurosurgeons, and neurologists. INTERVENTIONS: Collection and analysis of information regarding healthcare providers' attitudes and beliefs. MEASUREMENTS AND MAIN RESULTS: All focus groups agreed that increased organ availability is a benefit but questioned the quality of organs recovered. Study participants identified a lack of standards for patient prognostication and cardiopulmonary death and a failure to prevent a conflict between patient and donor interests as obstacles to acceptance of organ donation after cardiac death. They questioned the practices and motives of colleagues who participate in organ donation after cardiac death, apprehensive that real or perceived impropriety would affect public perception. CONCLUSIONS: Healthcare providers are uncomfortable at the clinical juncture where end-of-life care and organ donation interface. Our findings are consistent with theories that care providers are hesitant to perform medical tasks that they consider to be outside the focus of their practice, especially when there is potential conflict of interest. This conflict appears to impose moral distress on healthcare providers and limits acceptance of organ donation after cardiac death. Future research is warranted to examine the effect of standardized procedures on reducing moral distress. The hypothesis generated by this qualitative study is that use of neutral third parties to broach the subject of organ donation may improve acceptance of organ donation after cardiac death.

Attitude of Health Personnel↗
PubMed2004

Connecting with others in the midst of stressful upheaval on September 11, 2001.

This study was originally planned from September tenth through twelfth to assess concurrent use of three real-time data sources during a usual day. When the World Trade Center towers collapsed, the plan expanded to describe 24-hour blood pressure and heart rate, natural environment word use, television viewing/radio listening, and self-reported diary feelings for six undergraduate students in the midst of stressful upheaval. Heart rate, "we" word-use and television viewing/radio listening increased over time. Higher negative and lower positive feelings/emotions occurred during morning hours on September 11. Students connected with others and shared good thoughts. Measurement with real-time data sources was informative.

Attitude to Health↗
PubMed2004

Community-based participatory research to prevent substance abuse and HIV/AIDS in African-American adolescents.

Adolescence is a time for exploration and risk-taking; in today's urban environment, with the twin threats of substance abuse and HIV/AIDS, the stakes are particularly high. This paper describes a community-based participatory research project to design, implement, and evaluate a faith-based substance abuse and HIV/AIDS prevention program for African-American adolescents. A coalition of university-based investigators and African-American church member stakeholders collaborated on all aspects of Project BRIDGE, the 3-year intervention to reduce substance abuse and HIV/AIDS in African-American adolescents. Our results support the use of community-based participatory research to create desirable change in this setting. Adolescents who participated in Project BRIDGE reported significantly less marijuana and other drug use and more fear of AIDS than a comparison group. Project BRIDGE has been designated an official ministry of the church and the program has been extended to others in the larger metropolitan community. The church now has a well-trained volunteer staff University faculty developed skills in negotiating with community-based settings. The coalition remains strong with plans for continued collaborative activities.

Adolescent↗
PubMed2004

Developmental, gender, and ethnic group differences in moods and ambulatory blood pressure in adolescents.

BACKGROUND: Adolescence is characterized by profound changes in physical, psychological, and social functioning thought to be accompanied by intense and varying moods. PURPOSE: Within a psychophysiological framework, this study examined the prevalence of 12 self-reported mood states of adolescents; investigated associations between specific mood states and ambulatory blood pressure readings; and explored effects of interactions among moods, gender, ethnic group, and maturation on ambulatory blood pressures. METHODS: The sample included 371 African American, European American, and Hispanic American adolescents 11 to 16 years old. Systolic (SBP) and diastolic (DBP) blood pressures were measured every 30 min with an ambulatory monitor and were synchronized with electronic activity monitoring and moods self-recorded during waking hours in a checklist diary. RESULTS: Moods differed significantly by gender, ethnic group, and maturation. Controlling for height, maturation, gender, ethnic group, mother's education, position, location, activity, other moods, and interactions of moods with other variables in a multilevel, random coefficients regression model, both positive and negative mood states were associated with higher levels of SBP and DBP; being relaxed or bored, or having a feeling of accomplishing things were associated with lower SBP and DBP. There were significant interaction effects of moods with physical maturity, gender, and ethnic group on ambulatory SBP and DBP. CONCLUSIONS: Further study of the modifying effects of gender, ethnic group, and stage of development on reports of moods, and their associations with cardiovascular responses is recommended.

Adolescent↗
PubMed2003

Addressing current challenges to cardiac rehabilitation care.

Cardiac rehabilitation, the structured programming of exercise and risk reduction teaching and counseling to promote healthy living with heart disease, is grounded in a strong nurse-patient relationship. This relationship provides a foundation for meeting current healthcare challenges. Three challenges are presented and addressed through specific examples. The challenge of the changing cardiac rehabilitation population is addressed through the example of the heart failure patient. The challenge to create innovative programming is addressed through the example of the Therapeutic Rehabilitative Intensive Program, developed to meet the needs of people who live in communities without cardiac rehabilitation services. The challenge to measure outcomes is addressed through the example of choosing a blood pressure measurement method. In addressing each challenge, the role of the advanced practice nurse is described.

Blood Pressure↗
PubMed2002

Expressing health experience through embodied language.

PURPOSE: To describe embodied language for Japanese elders who suffered a stroke or cardiac disease within the previous year. Embodied language is the overlap of feeling and temporal word use with blood pressure during descriptions of health experience. DESIGN: Exploratory. METHODS: Blood pressure and word use were recorded simultaneously when 17 cardiac and 20 stroke participants described their health experiences for 4 minutes. Blood pressure was measured using a tonometric monitor and word use was measured using linguistic analysis software. Descriptive and nonparametric statistics were used. FINDINGS: Participants with strokes retained higher blood pressure after talking than did cardiac participants. The two groups showed contrasting relationships between word use and blood pressure, particularly for temporal words. CONCLUSIONS: This collaborative research between Japanese and American colleagues was a step toward deciphering shared values, which are important to understanding health for people who have lived through life-changing illness events.

Aged↗
PubMed2002

A review of nursing research on blood pressure.

PURPOSE: To provide this second 10-year review of nursing research on blood pressure (BP) and to focus attention on incorporating biopsychosocial factors affecting BP in nursing research. ORGANIZING CONSTRUCT: Blood pressure is a dynamic, multidimensional, cardiovascular indicator of a person's state rather than a one-dimensional static measurement. METHODS: This 10-year literature review 1990-1999 included 54 nursing research articles with BP as an outcome measure. Four nursing research journals were reviewed to identify all nurse-authored articles investigating BP as an outcome variable in adult populations. Inclusion of individual characteristics, environmental factors, dynamic nature of blood pressure, and interpersonal aspects of blood pressure were assessed for each article. FINDINGS: Age, gender, and health status were mentioned consistently in both decades. Reporting of socioeconomic, occupational, educational, activity, and martial status remained low. Descriptions of environments increased, and automated devices were the most common method for BP assessment. Less than half of the articles included a description of the person measuring the BP. Measurements of BP under multiple conditions increased, but measurement within conditions did not. CONCLUSIONS: Advances in technology and data analysis have increased knowledge of the dynamic nature of BP, but recognition of the complex nature of BP has not progressed rapidly over the last 2 decades.

Adult↗
PubMedDate not supplied

School-based health center viability: application of the COPC model.

Providing effective primary and preventive health care to adolescents is challenging. Traditional medical and nursing models have had little success in guiding health care for the individual adolescent. A community-based model would aim programs and intervention at high-risk adolescents identified as needing treatment. Community-Oriented Primary Care (COPC) bridges the gap between primary care and public health to evaluate and improve the delivery of health care to identified populations. The COPC model was used to develop and implement an adolescent school-based health center in a southwestern border community. The four process steps based on the COPC model include: identifying the community of interest, identifying the health problem, developing and implementing intervention(s), and conducting ongoing evaluation. Key stakeholders from the medical, educational, and consumer groups were invited to participate in the first and second steps. Representatives of various school adolescent subcultures formed a group of promotores (health promoters) to monitor, advise, and contribute to the process. The Dartmouth COOP survey was selected to identify health concerns and risks of the targeted high school. The promotores prepared and administered the survey to 1,116 students. Results were used to design the initial health center program components using an interdisciplinary team to implement interventions aimed at the major health concerns and risks identified by the COOP. A short feedback loop contributed to program refinements, and ongoing evaluation continues to shape the practice of health care providers in the school-based health care center.

Adolescent↗
PubMedDate not supplied

Story theory: advancing nursing practice scholarship.

Stories are a fundamental dimension of human experience and nursing practice. Story theory describes a narrative happening that occurs through intentional nurse-person dialogue. Seven inquiry phases are associated with story theory, including gathering the story, reconstructing the story, connecting it to the literature, naming the complicating health challenge, describing the story plot, identifying movement toward resolving, and gathering additional stories. This article describes the use of story theory to advance nursing practice scholarship in both academic and everyday nursing practice.

Holistic Health↗
PubMedDate not supplied

Heeding the behavioral message of elders with dementia in day care.

Embodied language is unity of bodily, linguistic, and behavioral descriptors, expressed as health. Disagreement behavior, client unwillingness to respond as requested when uncomfortable in a situation, occurs in elders with dementia. Case study analysis suggests that agitation/aggression may be avoided if disagreement behavior is recognized as a message of discomfort.

Aged↗
PubMedDate not supplied

Anger in adolescents: sex, ethnicity, age differences, and psychometric properties.

BACKGROUND: The State-Trait Anger Expression Inventory (STAXI), a self-report questionnaire, is designed to measure the experience and expression of anger. Reliability and validity of the STAXI have been well established among African and European Americans aged 13 years and older. However, little is known of the use of this instrument among adolescents younger than 13 years and Hispanic American adolescents. OBJECTIVES: Objectives were (a) to test ethnic, sex, and age group differences in STAXI scores in a sample of 11-to-16-year-old African, Hispanic, and European American adolescents; and (b) to assess the psychometric properties of the STAXI among these same adolescents with special emphasis on Hispanic youths, for whom no data are available. METHODS: A cross-sectional design was used with stratified quota sampling techniques. Participants (N = 394) were African, Hispanic, and European Americans aged 11-16 years and were drawn from one public middle school and two public high schools in Houston, Texas. RESULTS: Internal consistency reliability for the anger scales (STAXI) ranged from 0.61 (anger-in) to 0.91 (state-anger) for the younger group (aged 11-13 years), and 0.68 (anger-in) to 0.88 (state-anger) for the older Hispanic Americans (aged 14-16). No notable differences were seen among the three ethnic groups in regards to internal consistency. Results of factor analyses of the five anger scales were similar to those reported originally by the scale author. Ethnicity and age had statistically significant main effects on the anger scales, and there was only one interaction. DISCUSSION: The use of the STAXI among a tri-ethnic adolescent population is warranted. The anger-in scale may be less reliable, especially among younger adolescents.

Adolescent↗
PubMedDate not supplied

Bridging distance and culture with a cyberspace method of qualitative analysis.

This article describes a qualitative research method that weds the cyberspace technology of e-mail with a phenomenological research approach. Examples are provided from 2 separate data sets. One data set explored the meaning of health for Japanese elders; the second explored Chinese nurses' experience of taking care of patients with severe acute respiratory syndrome. Lessons learned while using the cyberspace method are discussed, including guidance for organizing a long-distance research team, the central place of trust, and the time when e-mail communication demands to be supplemented with face-to-face interaction. The potential for bridging distance and culture with this cyberspace method is introduced for consideration and critique.

Aged↗