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Biomedical subjects

Barbara Resnick

Publications and source records attributed to Barbara Resnick.

66 records · Page 4Linked to original sources
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Exercise intervention in patients with chronic obstructive pulmonary disease (CE).

Chronic obstructive pulmonary disease (COPD) is characterized by worsening airflow obstruction. In its late stages, patients experience decreased physical function and increased incidents of pneumonia, pulmonary hypertension, cor pulmonale, and chronic respiratory failure. Patients who regularly participate in moderate exercise experience greater control of symptoms and increased functional capacity compared with those being treated by pharmacologic measures alone. Guidelines for a comprehensive exercise program are provided. The Seven Step Approach is discussed as a means of motivating older adults with COPD to incorporate physical exercise into their daily activity. Encouraging exercise in older adults with COPD will help these individuals reach and maintain their highest level of function and quality of life.

Activities of Daily Living↗
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Testing a theoretical model of exercise behavior for older adults.

BACKGROUND: Although there are many known benefits to exercise, only 10-30% of older adults report regular exercise. Understanding the factors that explain exercise behavior in older adults will help structure interventions that motivate these individuals to initiate and adhere to regular exercise. OBJECTIVE: The purpose of this study was to test the impact of components from two theoretical perspectives that explain exercise behavior, social cognitive theory, and the transtheoretical model. METHODS: This was a descriptive study using a sample of 179 older adults living independently in an East Coast continuing care retirement community (CCRC). A single one-time interview was completed and included: (a) stage of change for exercise, (b) self-efficacy and outcome expectations, (c) health status, (d) fear of falling, and (e) exercise activity. Model testing used structural equation modeling. RESULTS: Testing of the hypothesized model showed that 11 of the 22 paths were statistically significant. Health status and social support influenced self-efficacy and outcome expectations which directly influenced stage of change and exercise. Social support likewise directly influenced stage of change. Together the variables in the model explained 64% of exercise behavior in older adults. There was a poor fit of the hypothesized model to the data with a chi2 of 144.7, degrees of freedom (df) of 23 and a ratio of 6.3. The revised model fit the data better chi2 = 80.5, df = 19, p <.05, chi2/df = 4.2) and there was improved fit when compared to the hypothesized model (chi2 difference of 64.0, df difference of 4, p < or = l. DISCUSSION: The combined testing of the mediating components of the theory of self-efficacy as well as the incorporation of the stage of change to explain exercise behavior in older adults suggests that both of these approaches are useful. Stage of change may be particularly useful to help determine the most appropriate intervention to increase activity and exercise in older adults.

Aged↗
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Recruitment of older women: lessons learned from the Baltimore Hip Studies.

OBJECTIVES: This study used a qualitative approach in which participants were asked to write about their experiences in recruiting older women into either one of two exercise intervention studies that are part of the Baltimore Hip Studies. The sample included 8 researcher nurses all women, White, and 42-53 years of age. BACKGROUND: Older adults, particularly older women, are less likely to participate in research studies when compared to their younger counterparts. The purpose of this study was to explore the techniques successfully used by research nurses in the Baltimore Hip Studies to recruit older women after hip fracture into exercise intervention studies. METHOD: Data analysis was performed using basic content analysis (Crabtree & Miller, 1992; Miles & Huberman, 1984) "in vivo" coding (Dowd, 1991), or "grounded" coding (Glaser & Strauss, 1967), which involves using the informants' own words to capture a particular idea. RESULTS: A total of 16 codes were identified and reduced to nine themes. Seven themes focused on techniques that facilitated recruitment: (a) caring for individuals; (b) emphasizing benefits; (c) eliciting support from others; (d) being an expert; (e) using role models; (f) using good timing; and (g) giving good first impressions. The remaining two themes identified barriers to recruitment: (a) time commitment and (b) lack of support. DISCUSSION: Based on these themes, specific recruitment techniques are recommended. Ongoing research, however, is needed to establish the most effective recruitment procedures with older women.

Adult↗
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Treatment fidelity in behavior change research: a case example.

BACKGROUND: Treatment fidelity refers to the methodological strategies used to monitor and enhance the reliability and validity of behavioral interventions. Assuring optimal treatment fidelity also may decrease the costs of a study and help the research team explain findings. APPROACH: The Behavioral Change Consortium developed a comprehensive model of treatment fidelity that incorporates 5 areas: (a) study design, (b) training providers, (c) delivery of treatment, (d) receipt of treatment, and (e) enactment of treatment skills. The definitions of these areas and a case example (Testing the Effectiveness of the Exercise Plus Program) are provided. RESULTS: There was evidence of treatment fidelity related to delivery based on careful monitoring of the study implementation. A comprehensive plan for training of the interventionists was provided, although evidence of treatment fidelity to training was not quantified. There were evidence based on observations of treatment sessions of delivery and receipt of the intervention and evidence of enactments based on evaluation of exercise calendars. DISCUSSION: The development and implementation of a treatment fidelity plan requires a careful conceptualization of what is relevant to treatment fidelity in any given study. Monitoring of treatment fidelity ideally requires direct or indirect observations of sessions, which can be built into the study design so that costs are minimal in terms of time and resources. Monitoring treatment fidelity allows research teams to truly test interventions and to develop and implement interventions that ultimately improve the overall health and well-being of individuals.

Models, Nursing↗
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Reliability and validity of the self-efficacy and outcome expectations for osteoporosis medication adherence scales.

PURPOSE: The purpose of this study was to test the reliability and validity of the self-efficacy and outcome expectations for osteoporosis medication adherence measures (SEOMA and OEOMA). DESIGN: This was a descriptive study involving a single face-to-face interview. SAMPLE: The study included 152 older adults with a mean age of 85.7 (+) 5.5 years, the majority of whom were Caucasian (99%), female (74%), and unmarried (75%). METHODS: In addition to the SEOMA and OEOMA measures, demographic information (age, gender, and marital status) and other health behaviors (exercise and osteoporosis medication use) were explored. RESULTS: There was evidence of reliability of the SEOMA and OEOMA based on internal consistency and R values. Evidence of the validity of the SEOMA and OEOMA measures was based on confirmatory factor analysis and hypothesis testing. CONCLUSION: This study is an important first step to developing reliable and valid measures of self-efficacy and outcome expectations for adherence to osteoporosis medications. IMPLICATIONS FOR NURSING PRACTICE: The SEOMA and OEOMA can be used to evaluate self-efficacy and outcome expectancy beliefs related to osteoporosis medication use in older adults and interventions developed to strengthen those beliefs and improve medication adherence.

Aged↗
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Testing the reliability and validity of computer-mediated social support measures among older adults: a pilot study.

With the increasing number of older adult online users, the Internet and e-mail are becoming a new source of social support for older adults. To assess this computer-mediated social support, two traditional social support measures were modified: (1) the Lubben Social Network Scale and (2) the Medical Outcomes Study Social Support Survey. The purpose of this pilot study was to test the reliability and validity of these modified measures. This study was a single group descriptive study with two data collection points. Data were collected using Web surveys. A total of 38 older adult participants completed the first survey; 35, the second survey. The findings of this preliminary study provided evidence for the reliability, content validity, and, to a limited extent, construct validity, of the modified measures. Additional studies with a larger representative sample are needed to further examine the psychometric aspects of these measures.

Aged↗
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Usability of health Web sites for older adults: a preliminary study.

Although an increasing number of Web sites are devoted to providing health information to older adults, many sites have usability problems unique to this population. The purpose of this study was to explore the usability of three health-promoting Web sites specifically designed for use by older adults. This descriptive study used two usability assessment methods: (1) a heuristic evaluation by four experts in Web usability and gerontology and (2) a usability test by 10 senior Web users with a mean age of 73.9. The design aspects identified as inappropriate for seniors by experts were as follows: small font size, too much information on one page, and a failure to provide instructions. The older adults in this sample preferred a simple design with clear instructions. During testing, these individuals expressed great interest in online health information. However, they needed instructions on how to search for credible health information online. Some usability-testing methods might need to be modified for older adults' specific needs.

Aged↗
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Development of theory-based, online health learning modules for older adults: Lessons learned.

Recently, the number of older adult online users has increased rapidly. In 2004, 22% of Americans aged 65 years or older (about 8 million) used the Internet, and 66% of them performed online searches for health information. The Web, therefore, can serve as a useful medium to educate older adults on selected health topics. In this study, the researchers developed four Web-based learning modules related to hip fracture prevention and tested the usability of these modules employing eight older adult online users. The findings from the usability tests demonstrated that the online learning modules were usable to the older adult participants. Additionally, these individuals could acquire health knowledge using these online modules. The important lessons learned through the research process will assist the researchers in conducting further studies in using health Web learning modules for older adults. A further study will be conducted to test the effects of these modules on preventing hip fractures.

Aged↗
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Nursing staff beliefs and expectations about continence care in nursing homes.

OBJECTIVE: The purpose of this qualitative study was to consider the current beliefs of nursing assistants and directors of nursing about management of urinary incontinence (UI) among the residents in nursing homes. DESIGN: This was a qualitative study using purposive sampling and a focus group methodology. SETTING AND SUBJECTS: Three focus groups including 38 participants were held in 2 different regions. Two of the focus groups comprised nursing assistants and 1 comprised directors of nursing. METHOD: The focus groups were facilitated by 2 different advanced practice nurses (BR and LJK), and 2 similar interview guides were used: 1 for the nursing assistants and 1 for the nurses. The interviews were tape recorded and transcribed verbatim; data were analyzed via content analysis. RESULTS: Ten themes were identified from the data; 3 focused on resident factors that influence UI, 4 related to staff and family contributors to UI, and 3 focused on recommendations to improve UI management in the nursing home setting. CONCLUSIONS: The findings from this study can be used to guide interventions to decrease or eliminate barriers to continence care and thereby facilitate the implementation of clinical practice guidelines and evidence-based interventions to improve urinary continence among nursing home residents.

Aged↗
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Testing the feasibility of implementation of clinical practice guidelines in long-term care facilities.

OBJECTIVES: The purpose of this study was to explore the feasibility of implementing two specific Clinical Practice Guidelines (CPGs), Pain Management and Falls and Fall Risk, developed by the American Medical Directors Association. DESIGN: This study used a combined quantitative and qualitative design using a single-group repeated-measures design for the quantitative component. SETTING: The study was done in 23 long-term care facilities in Maryland. PARTICIPANTS: Of 40 facilities that participated in a training program for CPG implementation, 32 were interested in implementing CPGs and 23 volunteered to participate in the study. Evaluation of the Falls CPG was based on 127 randomly selected cases preimplementation and 119 randomly selected cases postimplementation from the 23 facilities. Evaluation of the Pain CPG included 64 randomly selected cases preimplementation and 74 randomly selected cases postimplementation from the 23 facilities. Qualitative data was obtained from 20 of the directors of nursing. INTERVENTION: Thirteen of the facilities implement-ed the Falls CPG, 10 facilities implemented the Pain CPG, and eight facilities implemented both CPGs. MEASUREMENTS: Process indicators of CPG implementation were used in this study. Process indicators included five measurable items that were indicative of CPG implementation such as evidence of a pain assessment. RESULTS: Less than half (45%) of the original 40 facilities actually implemented at least one of the CPGs. Based on process indicators in those facilities that did implement the CPGs, there was evidence that the guidelines were being implemented. Qualitative data led to the development of four major themes: challenges to implementation, benefits of implementation, process recommendations, and recommendations for changes in the CPGs. CONCLUSION: The study provides some support for the feasibility of CPG implementation in facilities that voluntarily attempted to implement the guidelines. In addition, the findings provide some useful suggestions for how to facilitate the implementation process.

Accidental Falls↗