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Morgan JC, Jason KJ, Kemp CL, Bhattacharyya KK. A Collaborative Approach to Improving Care Outcomes for Residents in Assisted Living. Gerontol Geriatr Med 2024; 10:23337214231222981. [PMID: 38204919 PMCID: PMC10777796 DOI: 10.1177/23337214231222981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
Purpose: Assisted Living (AL) residents are embedded in "care convoys" comprised of a dynamic network of formal and informal care partners. Using the convoys of care model-a multi-level framework connecting care convoy properties to resident outcomes-we examined healthcare management and communication between convoy members. We recommend strategies to engage primary care in supporting collaboration, communication, and consensus-building for older adults and their convoys. Methods: Data were collected from the longitudinal study, Convoys of Care: Developing Collaborative Care Partnerships in AL. Fifty residents and their care convoy members (N = 169) were followed in eight AL homes in Georgia over 2 years. Original data were analyzed using Grounded Theory Methods of qualitative data, including formal and informal interviewing, participant observation, and record review. Results: The convoys of care model provide an innovative perspective that will assist providers in supporting AL residents and their care partners to achieve better care outcomes. Findings demonstrate the utility of understanding the structure and function of social resources and implications for improving healthcare outcomes. Conclusion: This research informs the work of physicians and mid-level providers with patients in AL by providing strategies to uncover specific social determinants of health. Recommendations for use in patient encounters are enumerated.
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Negotiating the care convoys for a diverse group of older Australians living in rural communities: a large qualitative study. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Whilst ageing in place is integral to international policy, there is less understanding of how individuals utilise formal services and informal supports in diverse rural environments to maintain their wellness and independence. Consequently, how older people negotiate their care within rural communities is subject to misconceptions. This paper draws on the convoy of care model to explore how older rural Australians negotiate their preferences and needs in the context of informal networks, availability of community resources, and the health and aged care system. The analysis draws on 60 in-depth interviews in six diverse rural communities across two Australian states. Three distinct care convoys are identified and demonstrate the interaction of multiple factors including individual preferences and needs, availability of family and community supports, and accessibility of local health and aged care services in the context of resource allocation. The findings highlight how families and communities compensate for a lack of accessible formal services. For older people without family and strong social networks, formal services are relied upon despite their inadequacy in some locales. This research has provided evidence that some Australian rural locales have limited resources resulting in challenges for older people to access home care and support. This results in many older people facing challenges to age in place. With aged care and health policy commonly designed for an urban context, our findings illustrate the importance of tailoring policy to respect the strengths and challenges existing in rural communities.
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Sutton K, Moore J, Armes J, Briggs E. Perceptions and experiences of the subjective well-being of people with glioblastoma: a longitudinal phenomenological study. Neurooncol Pract 2022; 10:79-88. [PMID: 36654773 PMCID: PMC9837778 DOI: 10.1093/nop/npac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Glioblastoma (GBM) is a devastating form of brain cancer, with a short life expectancy. In addition to this poor prognosis, people with GBM often experience symptoms that may have a profound impact on their subjective well-being (SWB). The aim of this study was to investigate the lived experiences and perceptions of people with GBM regarding their SWB. Methods The study adopted a longitudinal, hermeneutical phenomenological approach. Twenty-seven interviews were conducted with 15 patients over a period of two years. Most participants were interviewed twice on a face-to-face basis (during combined chemotherapy and radiotherapy, and again during adjuvant chemotherapy). The hermeneutic circle was used to guide data analysis. Results Data analysis identified four key themes that depicted the lived experiences and perceptions of SWB of people with GBM. "Experience of the disease" focuses on the impact of diagnosis, symptoms and side effects. "Daily life" relates to daily activities, family roles, work and social lives. "Coping" includes the importance of normality and goal-setting. "Experiences of care" focuses on the impact of the treatment schedule, experiences of care and impressions of the monitoring of QoL. Conclusion SWB is affected by a variety of factors throughout the GBM disease and treatment journey. The findings of this study suggest that healthcare professionals can enhance the SWB of people with GBM by providing personalized care that supports people to set themselves goals for the future and retain a degree of normality wherever possible.
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Affiliation(s)
- Katie Sutton
- Corresponding Author: Katie Sutton, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK ()
| | - Jaqualyn Moore
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
| | - Jo Armes
- University of Surrey, Kate Granger Building, Priestley Road, Surrey Research Park, Guildford, GU2 7YH, UK
| | - Emma Briggs
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
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Fitzroy AF, Kemp CL, Burgess EO. "I'm not terribly lonely": Advancing the understanding of intimacy among older adults. J Aging Stud 2022; 61:101005. [PMID: 35654540 PMCID: PMC9163450 DOI: 10.1016/j.jaging.2022.101005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Intimacy, a social relationship component, continues to be essential in later life, including for older adults in long-term care such as assisted living. Yet, no previous study has conceptualized how individuals experience intimacy holistically (i.e., broadly defined) and within the context of later life, health decline, and long-term care. The purpose of this analysis was to provide an in-depth understanding of intimacy in the lives of older adults in assisted living. RESEARCH DESIGN AND METHODS Using grounded theory methods, we analyzed data from the "Convoys of Care" (Kemp, PI: R01AG044368) longitudinal, qualitative research project. Data consisted of 2224 h of participant observation and interviews with 28 assisted living residents (aged 58-96), and their care partners (n = 114) followed over two years from four diverse assisted living communities. RESULTS Residents' experience with intimacy was a process involving four dimensions: emotional, intellectual, spiritual, and physical. Intimacy occurred in platonic or romantic forms and was dynamic over time alongside residents' intimacy needs. Residents engaged in an ongoing process requiring that they manage their needs while negotiating intimacy opportunities and constraints. DISCUSSION AND IMPLICATIONS Our findings expand the current conceptualization of intimacy in later life, specifically in the context of long-term care. Findings indicate the need for an approach to long-term care that addresses individuals' intimacy needs and preferences.
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Affiliation(s)
| | - Candace L Kemp
- Gerontology Institute, Georgia State University, Georgia.
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5
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Burgess EO, Kemp CL, Bender AA. "It's Going to be Different for Everyone": Negotiating Quality of Life and Care Priorities Within Care Convoys. J Aging Health 2021; 34:602-613. [PMID: 34866447 DOI: 10.1177/08982643211052367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The overall goal of this analysis was to learn about residents' quality of life and quality of care in assisted living over time and from multiple viewpoints within support networks. Method: This grounded theory analysis examined qualitative data collected from 50 residents and 169 of their care network members followed over two consecutive 2-year periods in 8 diverse settings. Results: Quality involved a dynamic process of "negotiating priorities," which refers to working out what is most important for residents' quality of life and care. Resident and care partner priorities were not always consistent or shared, in part because quality is personal, subjective, dynamic, and situational. Discussion: Communication and collaboration among formal and informal care partners are vital to residents' ability to age in place with a high quality of life and quality care.
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Affiliation(s)
| | - Candace L Kemp
- The Gerontology Institute, Georgia State University, Atlanta, GA, USA
| | - Alexis A Bender
- Emory University School of Medicine, Division of Geriatrics and Gerontology, Atlanta, GA, USA
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6
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Morgan JC, Kemp CL, Barmon C, Fitzroy A, Ball MM. Limiting and Promoting Resident Self-Care in Assisted Living. J Gerontol B Psychol Sci Soc Sci 2021; 76:1664-1672. [PMID: 33471097 PMCID: PMC8577204 DOI: 10.1093/geronb/gbab016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Assisted living (AL) residents often manage multiple chronic conditions, functional and/or cognitive decline along with their individual needs and preferences for a full life. Although residents participate in their own care, little is known about their self-care activities and how to support them. This analysis focuses on residents' self-care and theorizing the dynamic, socially embedded process of negotiating self-care. METHODS We analyze data from a grounded theory study informed by the Convoys of Care model. Participants included 50 focal residents and 169 paid and unpaid convoy members in eight AL homes; each resident convoy was followed up for 2 years. Data collection included participant observation, interviews, and resident record review. RESULTS To the extent possible, most AL residents were involved in self-care related to activities of daily living, health promotion, and social, emotional, and mental well-being. Residents and care partners engaged in a dynamic process of limiting and promoting self-care activities. Multiple factors influenced self-care, including residents' past self-care behaviors, caregiver fear and availability, and the availability of services and supports. DISCUSSION Strategies for promoting self-care must involve residents and care partners and include convoy education in collaborative goal-setting, prioritizing care that supports the goals, and putting resources in place to support goal achievement.
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Affiliation(s)
- Jennifer C Morgan
- Gerontology Institute, Georgia State University, Atlanta, USA
- Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, USA
| | - Candace L Kemp
- Gerontology Institute, Georgia State University, Atlanta, USA
- Department of Sociology, Georgia State University, Atlanta, USA
| | - Christina Barmon
- Department of Sociology, Central Connecticut State University, New Britain, USA
| | - Andrea Fitzroy
- Department of Sociology, Georgia State University, Atlanta, USA
| | - Mary M Ball
- Gerontology Institute, Georgia State University, Atlanta, USA
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Bluvstein I, Ifrah K, Lifshitz R, Markovitz N, Shmotkin D. Vulnerability and Resilience in Sensitive Research: The Case of the Quantitative Researcher. J Empir Res Hum Res Ethics 2021; 16:396-402. [PMID: 34180723 DOI: 10.1177/15562646211027418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The emotional experiences of quantitative researchers, particularly while conducting sensitive research, are largely neglected. This article aims to advance the awareness of possible emotional strains for quantitative researchers engaged in sensitive research. It qualitatively assesses the ethical and emotional experiences of quantitative researchers conducting a study on aging of bereaved parents and people with a physical disability. Based on the detailed minutes of 66 weekly research meetings held during 2015-2017, a thematic analysis of the researchers' experiences was performed. Our analysis identified two main themes: vulnerability and resilience. We delineate these themes, along with their subthemes and affinity to vicarious traumatization, moral stress, and vicarious posttraumatic growth. The current study is among the first to introduce the emotional and ethical experiences of the quantitative researcher. Tentative recommendations for the advancement of the researcher's safety and well-being by training, institutional support, self-care skills, and policy development are provided.
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Affiliation(s)
- Irit Bluvstein
- The Herczeg Institute on Aging, 26745Tel Aviv University, Tel Aviv, Israel.,The Nursing Department, Sackler Faculty of Medicine, 26745Tel Aviv University, Tel Aviv, Israel.,Department of Multi-Disciplinary Studies, Kinneret Academic College, Sea of Galilee, Israel
| | - Kfir Ifrah
- The Herczeg Institute on Aging, 26745Tel Aviv University, Tel Aviv, Israel.,Faculty of Social and Community Sciences, 54619Ruppin Academic Center, Emek Hefer, Israel
| | - Rinat Lifshitz
- The Herczeg Institute on Aging, 26745Tel Aviv University, Tel Aviv, Israel.,Department of Management and Economics, 42715The Open University of Israel, Raanana, Israel
| | - Noam Markovitz
- The Herczeg Institute on Aging, 26745Tel Aviv University, Tel Aviv, Israel
| | - Dov Shmotkin
- The Herczeg Institute on Aging, 26745Tel Aviv University, Tel Aviv, Israel.,School of Psychological Sciences, 26745Tel Aviv University, Tel Aviv, Israel
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Kemp CL. #MoreThanAVisitor: Families as "Essential" Care Partners During COVID-19. THE GERONTOLOGIST 2021; 61:145-151. [PMID: 33295960 PMCID: PMC7799094 DOI: 10.1093/geront/gnaa161] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 11/30/2022] Open
Abstract
The public health response to the current Coronavirus pandemic in long-term care communities, including assisted living, encompasses prohibiting visitors. This ban, which includes family members, has been criticized for being unfair, unhealthy, and unsafe. Against this backdrop, I examine the roles family play in residents' daily lives and care routines. I argue that classifying family as "visitors" rather than essential care partners overlooks their critical contributions and stems from taken-for-granted assumption about gender, families, and care work, and I demonstrate why families are more than visitors. Policies that ban family visits also reflect a narrow understanding of health that focuses on mitigating infection risk, but neglects overall health and well-being. This policy further stems from a limited comprehension of care relations. Research shows that banning family visits has negative consequences for residents, but also families themselves, and direct care workers. I argue that identifying ways to better understand and support family involvement is essential and demonstrate the utility of the Convoys of Care model for guiding the reconceptualization of family in long-term care research, policy, and practice during and beyond the pandemic.
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Affiliation(s)
- Candace L Kemp
- The Gerontology Institute and Department of Sociology, Georgia State University, Atlanta, USA
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Kemp CL, Ball MM, Jason K, Appel JAD, Fitzroy AF. Communicative Competence: Responding to Residents' Health Changes in Assisted Living. THE GERONTOLOGIST 2020; 60:754-764. [PMID: 31504482 DOI: 10.1093/geront/gnz119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Frail and disabled individuals, including assisted living (AL) residents, are embedded in care convoys composed of dynamic networks of formal and informal care partners. Yet, little is known about how care convoys operate over time, especially when health changes occur. Thus, our aim was to provide an in-depth understanding of care convoy communication during times of residents' health changes in AL. RESEARCH DESIGN AND METHODS Data for this analysis come from a Grounded Theory study that involved 50 residents and their care convoy members (n = 169) from 8 diverse AL communities followed over 2 years. Researchers conducted formal and informal interviewing, participant observation, and record review. RESULTS We identified "communicative competence" as an explanatory framework in reference to a resident's or care partner's ability, knowledge, and action pertaining to communication and health change. Individual and collective competencies were consequential to timely and appropriate care. Communication involved: identifying; assessing significance; informing, consulting or collaborating with others; and responding to the change. Variability in communication process and properties (e.g., pace and timing; sequencing, timing, content, and mode of communication) depended on multiple factors, including the nature of the change and resident, informal and formal caregiver, convoy, AL community, and regulatory influences. DISCUSSION AND IMPLICATIONS Formal and informal care partners need support to establish, enhance, and maintain communicative competence in response to health changes. Findings reinforce the need for timely communication, effective systems, and well-documented accessible health care directives and have implications that are applicable to AL and other care settings.
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Affiliation(s)
- Candace L Kemp
- The Gerontology Institute, Georgia State University, Atlanta.,Department of Sociology, Georgia State University, Atlanta
| | - Mary M Ball
- The Gerontology Institute, Georgia State University, Atlanta
| | - Kendra Jason
- Department of Sociology, University of North Carolina at Charlotte
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Lambotte D, Smetcoren AS, Zijlstra GAR, De Lepeleire J, De Donder L, Kardol MJM. Meanings of Care Convoys: The Structure, Function, and Adequacy of Care Networks Among Frail, Community-Dwelling Older Adults. QUALITATIVE HEALTH RESEARCH 2020; 30:583-597. [PMID: 31303115 DOI: 10.1177/1049732319861934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Researchers propose that the convoy of care model should be used to study care networks of frail, older individuals. Care convoys are defined as the evolving collection of individuals who may or may not have close personal connections to the recipient or to one another, but who provide care, including help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), socio-emotional care, skilled health care, monitoring, and advocacy. This study reports on community-dwelling older adults' experiences of their care convoy, how care convoys change over time, and perceived (positive) outcomes. A qualitative analysis among 65 semi-structured interviews with frail, community-dwelling older adults demonstrates a great variety in the composition of care convoys. Participants were often actively involved in their care convoy and valued the social/relational aspect of care. Care and support covered a wide range of activities, with some activities being provided by specific types of caregivers. Participants expressed the adequacy of their care convoy in terms of satisfaction and sufficiency. Noteworthy, participants who were satisfied with their care convoy did not necessarily receive sufficient help. Policies and practice should recognize the relational aspect of care, the complex interplay between all actors, and the dynamic character of care convoys.
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11
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Kemp CL, Ball MM, Perkins MM. Individualization and the Health Care Mosaic in Assisted Living. THE GERONTOLOGIST 2020; 59:644-654. [PMID: 29917071 DOI: 10.1093/geront/gny065] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Assisted living (AL) is a popular residential long-term care option for frail older adults in the United States. Most residents have multiple comorbidities and considerable health care needs, but little is known about their health care arrangements, particularly over time. Our goal is to understand how health care is managed and experienced in AL by residents and their care network members. RESEARCH DESIGN AND METHODS This grounded theory analysis focuses on the delivery of health care in AL. Qualitative data were gathered from 28 residents and 114 of their care network members followed over a 2-year period in 4 diverse settings as part of the larger study, "Convoys of Care: Developing Collaborative Care Partnerships in Assisted Living." RESULTS Findings show that health care in AL involves routine, acute, rehabilitative, and end-of-life care, is provided by residents, formal and informal caregivers, and occurs on- and off-site. Our conceptual model derived from grounded theory analysis, "individualizing health care," reflects the variability found in care arrangements over time and the multiple, multilevel factors we identified related to residents and caregivers (e.g., age, health), care networks (e.g., size, composition), residences (e.g., ownership), and community and regulatory contexts. This variability leads to individualization and a mosaic of health care among AL residents and communities. DISCUSSION AND IMPLICATIONS Our consideration of health care and emphasis on care networks draw attention to the importance of communication and need for collaboration within care networks as key avenues for improving care for this and other frail populations.
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Affiliation(s)
- Candace L Kemp
- The Gerontology Institute, Georgia State University, Atlanta.,Department of Sociology, Georgia State University, Atlanta
| | - Mary M Ball
- Division of General and Geriatric Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia
| | - Molly M Perkins
- Division of General and Geriatric Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia.,Department of Sociology, Emory University, Atlanta, Georgia.,Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Alabama
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12
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Kemp CL, Ball MM, Morgan JC, Doyle PJ, Burgess EO, Perkins MM. Maneuvering Together, Apart, and at Odds: Residents' Care Convoys in Assisted Living. J Gerontol B Psychol Sci Soc Sci 2019; 73:e13-e23. [PMID: 29401238 DOI: 10.1093/geronb/gbx184] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 12/28/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives Frail and disabled individuals such as assisted living residents are embedded in "care convoys" comprised of paid and unpaid caregivers. We sought to learn how care convoys are configured and function in assisted living and understand how and why they vary and with what resident and caregiver outcomes. Method We analyzed data from a qualitative study involving formal in-depth interviews, participant observation and informal interviewing, and record review. We prospectively studied 28 residents and 114 care convoy members drawn from four diverse assisted living communities over 2 years. Results Care convoys involved family and friends who operated individually or shared responsibility, assisted living staff, and multiple external care workers. Residents and convoy members engaged in processes of "maneuvering together, apart, and at odds" as they negotiated the care landscape routinely and during health crises. Based on consensus levels, and the quality of collaboration and communication, we identified three main convoy types: cohesive, fragmented, and discordant. Discussion Care convoys clearly shape care experiences and outcomes. Identifying strategies for establishing effective communication and collaboration practices and promoting convoy member consensus, particularly over time, is essential to the creation and maintenance of successful and supportive care partnerships.
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Affiliation(s)
- Candace L Kemp
- The Gerontology Institute, Georgia State University, Atlanta, Georgia.,Department of Sociology, Georgia State University, Atlanta, Georgia
| | - Mary M Ball
- Division of General and Geriatric Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia
| | - Jennifer Craft Morgan
- The Gerontology Institute, Georgia State University, Atlanta, Georgia.,Department of Sociology, Georgia State University, Atlanta, Georgia.,Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
| | - Patrick J Doyle
- Brightview Senior Living, Baltimore, Maryland and Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Elisabeth O Burgess
- The Gerontology Institute, Georgia State University, Atlanta, Georgia.,Department of Sociology, Georgia State University, Atlanta, Georgia
| | - Molly M Perkins
- Division of General and Geriatric Medicine, Emory School of Medicine, Emory University, Atlanta, Georgia.,Department of Sociology, Emory University, Atlanta, Georgia and Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center (GRECC), Atlanta, Georgia
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13
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SmithBattle L, Lorenz R, Reangsing C, Palmer JL, Pitroff G. A methodological review of qualitative longitudinal research in nursing. Nurs Inq 2018; 25:e12248. [DOI: 10.1111/nin.12248] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Lee SmithBattle
- School of Nursing; Saint Louis University; St. Louis Missouri
| | - Rebecca Lorenz
- UB School of Nursing; University at Buffalo; Buffalo New York
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