Looking back to move forward: Creating a blueprint for success for nurse scientists in the Veterans Health Administration.

AIM: The purpose of this manuscript is to report the findings of a qualitative content analysis of interviews with VA Nurse Scientists about work life experiences, barriers, and facilitators across the enterprise. BACKGROUND: The VA enterprise is widely variable in terms of size, services, research activity, and budget. For this reason, the roles of nurses with a research-focused doctorate are also quite diverse. METHODS: We purposively sampled 18 PhD prepared Nurse Scientists based on a variety geographic locations, titles, and years in the field and who conduct research. We conducted semi-structured interviews over the virtual platform, WebEx. Interviews, averaging 1 h in length, were conducted between April and May 2021. We analyzed interviews using deductive and inductive content analysis. RESULTS: We found five key factors affecting VA Nurse Scientists. Each factor emerged as an important issue influencing whether Nurse Scientists reported being successful, supported, and productive in their research. These include having: 1) mentorship, 2) supportive leadership 3) available resources, 4) respect and understanding from clinical and research colleagues who understand a Nurse Scientist's role in research, and 5) a career pathway. CONCLUSIONS: VA Nurse Scientists are leaders and innovators who generate evidence to improve health outcomes and promote equity in health and health care of Veterans, their families, and caregivers. Results from this project suggest that many Nurse Scientists need additional mentorship, resources, and networks to advance their development, increase their funding success, and maximize the impact of their role, ultimately enhancing care of Veterans and their families.

End-of-Life Symptoms in Adult Patients With Stroke in the Last Two Years of Life: An Integrative Review.

BACKGROUND: Stroke is a leading cause of death globally, yet End-of-Life (EOL) symptoms and their management in these patients are not well understood. PURPOSE: This integrative review aims to critique and synthesize research on EOL symptoms and symptom management in adult patients with stroke in the last 2 years of life in all settings. METHODS: The Whittemore and Knafl integrative review methodology guided this review. PubMed, CINAHL, Scopus, Web of Science, and Google Scholar were used for the literature search. Included studies were published in English and quantitatively examined symptoms and symptom management. Quality appraisal was guided by the Effective Public Health Practice Project (EPHPP) assessment tool. RESULTS: Seven studies, all rated weak, were included in this review. A total of 2175 adult patients from six countries were represented. Results are classified into three main themes: EOL symptom experience, symptom assessment, and symptom management. Commonly reported EOL symptoms among adults with stroke include both stroke-specific (dysphagia, dysarthria) and non-specific symptoms (pain, dyspnea, constipation, and psychological distress). However, communication difficulties and the infrequent use of standardized tools for symptom assessment limit what is known about the EOL symptom experience. Although the relief of pain is generally well-documented, dyspnea and anxiety are much more poorly controlled. CONCLUSIONS: There is a need for better assessment and management of EOL symptoms in patients with stroke. Established palliative and EOL care guidelines need to be incorporated into clinical practice to ensure access to high-quality care.

Age Moderates the Effect of Injury Severity on Functional Trajectories in Traumatic Brain Injury: A Study Using the NIDILRR Traumatic Brain Injury Model Systems National Dataset.

Age is a risk factor for a host of poor outcomes following traumatic brain injury (TBI), with some evidence suggesting that age is also a source of excess disability. We tested the extent to which age moderates the effect of injury severity on functional trajectories over 15 years post injury. Data from 11,442 participants from the 2020 National Institute of Disability and Independent Living Rehabiitation Research (NIDILRR) Traumatic Brain Injury Model Systems (TBIMS) National Dataset were analyzed using linear mixed effects models. Injury severity was operationally defined using a composite of Glasgow Coma Scale scores, structural imaging findings, and the number of days with post-trauma amnesia. Functioning was measured using the Glasgow Outcomes Scale-Extended. Age at injury was the hypothesized moderator. Race, ethnicity, sex, education, and marital status served as covariates. The results showed a significant confounder-adjusted effect of injury severity and age of injury on the linear slope in functioning. The age effect was strongest for those with mild TBI. Thus, the effects of injury severity on functional trajectory were found to be moderated by age. To optimize outcomes, TBI rehabilitation should be developed specifically for older patients. Age should also be a major focus in TBI research.

Beyond anger: emotion regulation and social connectedness in veterans with traumatic brain injury.

PRIMARY OBJECTIVE: Patients with traumatic brain injury (TBI) often present with emotion dysregulation. Most TBI rehabilitation has addressed this impairment primarily in relation to anger, irritability and aggressiveness. Yet, emotion regulation (ER) may have broader ramifications for psychological well-being. The present study examined ER's association to several aspects of social connectedness. RESEARCH DESIGN: Cross-sectional study Methods and procedures: 83 veterans with TBI who were outpatients at a VA medical rehabilitation service were interviewed in their homes. A 5-item ER subscale, drawn from the Patient Competency Rating Scale, was subjected to psychometric analysis and examined as a predictor of five social connectedness measures: community reintegration (CR), interpersonal functioning, quality of relationship with key family members and social role limitations due to physical problems and due to emotional problems. Sociodemographic, military and medical information was also collected. MAIN OUTCOMES AND RESULTS: The ER subscale showed good psychometric properties. ER contributed significantly to CR, interpersonal functioning and limitations in social roles. This underscores ER's role in social connectedness among veterans with TBI. CONCLUSIONS: Impairments in ER should be regarded as a risk factor for poor interpersonal outcomes, a target for mental health treatment and a focus for interventions aimed at improving psychological well-being in TBI.

Quality of relationship between veterans with traumatic brain injury and their family members.

OBJECTIVES: The quality of the relationship between patients with many illnesses and their family members has been shown to affect the well-being of both. Yet, relationship quality has not been studied in traumatic brain injury (TBI), and giving and receiving aspects have not been distinguished. The present study of veterans with TBI examined associations between relationship quality and caregiver burden, satisfaction with caregiving, and veterans' competence in interpersonal functioning, rated by veterans and family members. METHOD: In this cross-sectional study, 83 veterans and their family members were interviewed at home. Measures of quality of relationship, veterans' interpersonal competence and sociodemographics were collected for both, caregiver burden and satisfaction for family members only. RESULTS: As predicted, veteran-rated Qrel/Giving was associated with family-rated Qrel/Receiving, and veteran-rated Qrel/Receiving with family-rated Qrel/Giving. Lower caregiver burden and higher caregiving satisfaction were associated with higher Qrel/Receiving scores but not with Qrel/Giving scores. Veterans' interpersonal competence was associated with total Qrel as rated by either veterans or family members. CONCLUSIONS: Relationship quality should be included in family research in TBI, and giving and receiving aspects should be differentiated. Findings suggest that lower caregiver burden and greater satisfaction should be more achievable by increasing caregivers' sense of benefits received from the relationship.

Self-Reported Driving Difficulty in Veterans With Traumatic Brain Injury: Its Central Role in Psychological Well-Being.

BACKGROUND: The ability to drive is a core function supporting independent living. Traumatic brain injury (TBI) may impair driving capacity in numerous ways. Previous research has documented that individuals with TBI have more driving-related problems than other people and has identified predictors of driving status or capacity, mostly among civilians; however, no research has examined the implications of driving limitations for the well-being of individuals with TBI. OBJECTIVE: To examine the association between self-reported difficulty in driving with important domains of psychological well-being in veterans with TBI, with adjustment for posttraumatic stress disorder (PTSD) and years since most recent TBI. DESIGN: Cross-sectional. SETTING: Veterans' homes. PARTICIPANTS: A total of 61 veterans of the Global Wars on Terrorism diagnosed with TBI, all outpatients at a Veterans Affairs medical center rehabilitation service. METHODS: Home interviews as a baseline assessment for a larger randomized controlled trial. MAIN OUTCOME MEASURES: Community reintegration (extent of social participation), depressive symptomatology, and role limitations due to physical health problems and those due to emotional problems. Self-rated competence in driving was the predictor, and sociodemographic characteristics, diagnosis of PTSD, severity of TBI, and time since most recent TBI were covariates. RESULTS: Self-rated driving difficulty was associated with decreased community reintegration (ß = .280, P =.028), greater depressive symptomatology (ß = -.402, P < .001), and greater role limitations due to physical problems (ß = -.312, P =.011) and to emotional problems (ß = -.324, P = .006), after we adjusted for PTSD and other variables. DISCUSSION: The self-reported ability to drive seems to be central to psychological well-being in veterans with TBI, showing clear associations with depression, community reintegration, and health-related role limitations. These associations cannot be attributed to comorbid PTSD. CONCLUSION: Rehabilitation specialists should view driving difficulty as a risk factor for poor psychosocial outcomes in veterans with TBI and seek ways to compensate for the veteran's loss of driving if it is no longer advisable. LEVEL OF EVIDENCE: II.

Efficacy and acceptability of a home-based, family-inclusive intervention for veterans with TBI: A randomized controlled trial.

OBJECTIVE: Traumatic brain injury (TBI) often undermines community re-integration, impairs functioning and produces other symptoms. This study tested an innovative programme for veterans with TBI, the Veterans' In-home Programme (VIP), delivered in veterans' homes, involving a family member and targeting the environment (social and physical) to promote community re-integration, mitigate difficulty with the most troubling TBI symptoms and facilitate daily functioning. SETTING: Interviews and intervention sessions were conducted in homes or by telephone. PARTICIPANTS: Eighty-one veterans with TBI at a VA polytrauma programme and a key family member. DESIGN: This was a 2-group randomized controlled trial. Control-group participants received usual-care enhanced by two attention-control telephone calls. Follow-up interviews occurred up to 4 months after baseline interview. MAIN MEASURES: VIP's efficacy was evaluated using measures of community re-integration, target outcomes reflecting veterans' self-identified problems and self-rated functional competence. RESULTS: At follow-up, VIP participants had significantly higher community re-integration scores and less difficulty managing targeted outcomes, compared to controls. Self-rated functional competence did not differ between groups. In addition, VIP's acceptability was high. CONCLUSION: A home-based, family-inclusive service for veterans with TBI shows promise for improving meaningful outcomes and warrants further research and clinical application.

Cognitive, Affective, and Behavioral Dimensions of the Lower Urinary Tract Symptom Experience in Men With Parkinson's Disease.

OBJECTIVE: Lower urinary tract symptoms (LUTS) in persons with Parkinson's disease (PD) have received little research attention. To address this gap in our knowledge, we examined the LUTS experience in men with PD, guided by The Theory of Unpleasant Symptoms. METHODS: A qualitative design was used to explore the LUTS experience in this population. Participants were recruited from a Veterans' Affairs PD Center. Maximum variation sampling was used to select diverse participants for audiotaped open-ended interviews. Additional data sources included field notes collected during interviews and observation of a PD support group. The template organizing analytic approach was used to code transcribed interviews and field notes. RESULTS: Cognitive, affective, and behavioral dimensions of the LUTS experience were identified. Participants attributed LUTS to aging, medications, and effects of motor symptoms on their ability to respond to the urge to void. There was little awareness of the neurologic contributions of PD to LUTS, and most viewed LUTS as "something that you have to put up with." Negative effects of LUTS on self-identity were noted, which jeopardized relationships, intimacy, participation in social activities, and travel. Affective responses to LUTS, particularly embarrassment, had a profound impact on quality of life. Behavioral strategies to manage LUTS focused on "being prepared to go when you need to go" and consisted mostly of trial-and-error efforts. CONCLUSION: Misconceptions about LUTS among men with PD may result in underreporting, missed opportunities for professional assistance, and diminished health-related quality of life. Future research should focus on developing and testing nursing interventions to address cognitive, affective, and behavioral aspects of the LUTS experience in men with PD.

Depressed Affect and Dimensions of Religiosity in Family Caregivers of Individuals with Dementia.

Religiosity and mood have long been recognized as associated, but some patterns of associations suggest complex relationships. Using a multidimensional measure of religiosity, we explored the possibility that dimensions of religiosity may have (1) different strengths of association and (2) directions of association with depressed mood. We measured five dimensions of religiosity in 1227 family caregivers of persons with dementia, testing associations of each dimension to caregivers' depressive symptoms. In zero-order associations, higher scores on each religiosity dimension were associated with lower depression. Yet in hierarchical multiple regressions models, adjusting for other religiosity dimensions, different dimensions showed either no independent association, an independent association, or an inverse association with depressed mood. Frequency of prayer reversed directions of association-showing higher depression in caregivers who prayed more. Findings underscore the complex and sometimes bidirectional association between depressed mood and religiosity and argue for recognition of distinct dimensions of religiosity.

Effect of comparative data feedback on intensive care unit infection rates in a Veterans Administration Hospital Network System.

BACKGROUND: Infection control surveillance is not performed with standardized methodology within the Veterans Affairs (VA) health system. The purposes of this study were (1) to provide network hospitals with a standardized intensive care unit (ICU) surveillance system developed by the Centers for Disease Control and Prevention (CDC); (2) to compare ICU infection rates in hospitals that receive comparative data with those that do not; and (3) to compare network device-associated infection trends to national trends. METHODS: One VA Medical Center served as the central coordination site where surveillance data were analyzed with CDC's criteria and reported back to the sites. During 1999, the experimental group received risk-adjusted infection rates with national comparative data, and the control group received only risk-adjusted infection rates without comparative data. In 2000, hospitals in both groups received risk-adjusted infection rates accompanied by national data. RESULTS: In 1999, the device-associated infection rates were significantly higher in the control group compared with the experimental group. In the control group, the device-associated infection rates were significantly higher than the national comparative CDC rates; in the experimental group, the device-associated infection rates were not significantly different from the national comparative CDC rates. In 2000, the control group device-associated infection rates were not significantly different from the experimental group. The observed rates in both groups were not significantly different from the CDC rates. CONCLUSIONS: Study results suggest that infection rate outcomes may be reduced when national comparative data are provided. The study may serve as an infection control surveillance model for VA hospital networks.

Symptom prevalence, distress, and change over time in adults receiving treatment for lung cancer.

Adequate management of symptoms in adults with lung cancer is an important focus for clinical interventions. Knowledge of symptom prevalence and distress can be used to develop empirically based interventions that can potentially reduce distressing symptoms and improve quality of life. The purposes of this study were to describe which symptoms are most distressing, describe the prevalence of symptoms in adults receiving treatment for lung cancer, identify how symptoms change over time, and identify patient-related and clinical characteristics related to symptom distress. Data were available from 117 patients. Fatigue and pain were the most distressing symptoms for each group and at each time. Significant differences in distressing symptoms among the treatment groups were noted for nausea, fatigue, bowel pattern, and concentration at entry into the study and difficulty with appetite at 6 months. Many of the individual symptoms demonstrated a decrease in distress from 0 to 3 months and then an increase in distress levels from 3 to 6 months. Many of the individual symptoms were associated with demographic covariates and treatment group values but no consistent pattern emerged over time except for baseline symptom distress. Symptom distress at entry to the study was a strong predictor of nine distressing symptoms at 3 months and seven distressing symptoms at 6 months. Questionnaires such as the SDS may be useful as screening instruments to target those who need more intensive interventions.

Patterns of symptom distress in adults receiving treatment for lung cancer.

Knowledge of the patterns of symptom distress in adults receiving treatment for lung cancer is an important first step in developing interventions that can potentially lessen symptom distress. The purposes of this secondary analysis were to describe the changes in patterns of symptom distress over time in adults receiving treatment for lung cancer, and to examine the relationship of selected demographic and clinical characteristics to symptom distress. Complete data were available for 117 patients. The patterns of symptom distress in adults receiving treatment for lung cancer varied between treatment groups and over time. Symptom distress scores were moderate to high on entry into the study, indicating that symptom management in newly diagnosed lung cancer patients is essential and should begin early in the course of illness. Moreover, clinical interventions should be tailored to the type of treatment. Various demographic and clinical variables were weak and inconsistent predictors of symptom distress, underscoring the importance of examining the role of psychosocial factors in mediating symptom distress.