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Open Access Publications from the University of California

Scholarly Works (65 results)

  • Thesis
  • Peer Reviewed
UC Irvine Electronic Theses and Dissertations (2022)

Background: The nursing profession is dynamic, encompassing various roles and diverse skill sets. The intense and stressful demands in healthcare make for a challenging environment susceptible to high-pressure situations, a breeding ground for incivility. For decades, nurses have worked amidst a culture of lateral violence, commonly known as nurse bullying. Objective: The purpose of this study is to review contributing factors that predispose novice nurses to lateral violence to educate nurses about their risks and their vital role in ameliorating this negative culture. Novice nurses will be empowered through the provision of communication strategies against incivility. PICOT: This study was aimed to address the question: Would lateral violence awareness education with integration of communication promotion strategies to novice nurses improve their understanding of the issue, perception of workplace safety, and likelihood of addressing the problem? Research Design: This study used both qualitative and quantitative methods to survey nine new graduates from nurses hired at the University of California Irvine Medical Center using the Negative Behaviors in Healthcare survey. Data were collected using a survey through Qualtrics, a secure web-based data management software. Ethical considerations: The project was determined to be a Non-Human-Subject study and did not require approval by the Institutional Review Board (IRB). Participants were made aware that the study was voluntary. Consents were obtained from all respondents. Discussions: Lateral violence manifests as negative behaviors in healthcare systems that affect the workplace climate and nurses’ ability to deliver quality care that has been overlooked over time. The prevalence of this issue was discussed, and behaviors were defined and identified in this study. Conclusions: This study reviewed the proneness of the nurses, especially new graduate nurses or novice nurses with up to three years of employment, to this type of violence through collective literature. Necessary components were included in the education material and survey for this project. This offered the opportunity for new nurses to exercise professional scripts when incivility is encountered. The results suggest a systemwide approach of combining educational intervention with cognitive behavior training as a potential defense against lateral violence.

    Cover page: Defining and Identifying Negative Behavior: A Defense against Lateral Violence
    • Thesis
    • Peer Reviewed
    UC Irvine Electronic Theses and Dissertations (2025)

    Background: Irritability is a common yet understudied emotional state with significant implications for mental health, particularly among young adults. However, the temporal dynamics, psychological predictors, and functional consequences of irritability in young adults remain unclear. While traditionally examined within clinical populations, growing evidence suggests that irritability, both as a trait (tonic) and a state (phasic) phenomenon, impacts daily functioning and well-being in non-clinical populations. This study employed ecological momentary assessment (EMA) to capture fluctuations in irritability and their associations with stress, affect, and physical and mental functioning over two weeks.

    Methods: A total of 89 college-attending young adults (mean age = 20.02, SD = 1.41, age range = 18 to 25) completed twice-daily EMA surveys over 14 days (2,361 observations). Measures included validated irritability scales (Caprara Irritability Scale for trait and BITe for state), Perceived Stress Scale (PSS-10), PANAS (positive and negative affect), and the RAND SF-12 (mental and physical health). Mixed-effects modeling (MLM) was used to examine within- and between-person variations in irritability and its impact on daily functioning.

    Results: Trait irritability significantly predicted higher state irritability (B = 5.59, p = .04, β = .18), but state irritability was at the same time more reactive to perceived stress (B = .47, p < .001, β = .50) and negative affect (B = .34, p = .02, β = .21). Importantly, trait irritability was associated with greater impairments in mental (B = -10.98, p = .01) and physical functioning (B = -12.31, p < .001) across all time points. Positive affect buffered against the impact of irritability on functioning.

    Discussion: State irritability fluctuated with daily stressors, demonstrating momentary reactivity, whereas trait irritability reflected a stable vulnerability factor. These findings underscore irritability as a dynamic and transdiagnostic phenomenon, impacting daily well-being beyond clinical diagnoses. The results highlight perceived stress and negative affect as key modulators of state irritability, suggesting targets for interventions in young adult populations. Given the significant functional impairments associated with irritability — even in a non-clinical sample — these findings have implications for early identification and mental health interventions in young adults.

      Creative Commons 'BY-NC-ND' version 4.0 license
      • Thesis
      • Peer Reviewed
      UC Irvine Electronic Theses and Dissertations (2024)

      Background. Children diagnosed with cancer experience pain and myriad psychosocial symptoms throughout their disease progression and treatment which negatively impact their quality of life. Caregivers of children with cancer are also at risk for poorer psychosocial outcomes, including increased stress. Oral and systemic inflammation may be associated with psychosocial outcomes and pain in children and stress in caregivers, however this has not been studied extensively. The present study aims to 1) measure salivary inflammatory biomarker concentrations in children undergoing treatment for cancer and their primary caregivers; 2) determine how salivary inflammatory biomarkers are related to patient- and caregiver-reported pain and psychosocial outcomes; 3) investigate the impact of Pain Buddy, a mobile health (mHealth) ambulatory symptom management intervention, on salivary biomarkers of inflammation in both children and caregivers; and 4) explore factors that may be associated with salivary biomarkers of inflammation.Method. Children ages 8 to 18 with a first-time cancer diagnosis were recruited along with one primary caregiver (N = 22 dyads) to take part in a randomized controlled trial (RCT) over 8 weeks. Children reported their daily pain and cancer-related symptoms via a mobile application while receiving usual care. The intervention group (n = 14) received remote symptom monitoring and skills training for pain management and the attention-control group (n = 8) only reported on their pain. Child-caregiver dyads completed questionnaires at baseline, at the end of the intervention period, and at six months post-intervention. Dyads also collected saliva samples for three consecutive days at questionnaire timepoints along with reports of oral health, diet, and current medications. Results. Intercorrelations of salivary biomarkers and relationships between salivary biomarkers, pain, and psychosocial outcomes were examined among children and caregivers. In exploratory analyses, correlations were found between cancer diagnosis category and children’s T3 salivary TNF-α (rpb= -.358), as well as between cancer diagnosis category and caregivers’ baseline salivary IL-6 (rpb= .52). Conclusion. Overall, findings from the present study provide insight and novel methodology for studying potential immune processes (i.e., inflammation) associated with cancer among children within the first six months of a first-time diagnosis and their caregivers. The present study highlights the need for additional research with larger participant samples among children with cancer and their caregivers to determine how factors such as cancer diagnosis, medications, and self-reports of well-being may be related to salivary inflammatory biomarkers.

        Cover page: Salivary Inflammatory Biomarkers in the Context of Children’s Cancer-Related Pain, Psychosocial Well-Being, and Caregiver Perceived Stress
        • Article
        • Peer Reviewed
        UC Irvine Previously Published Works (2014)
        Outpatient surgery is extremely common in children, and approximately 4 million children experience significant pain after surgery in the USA each year. Management of children's postoperative pain in the home setting is suboptimal and is impacted by characteristics of children and parents, as well as the larger family and cultural context. In particular, developmental status of the child, parental beliefs regarding pain expression and analgesic use in children, cultural values and language barriers can affect management of children's postoperative pain. Targeting the myriad barriers to children's pain management by capitalizing upon the use of tailored interventions may help bridge the gap between the translation of pain management guidelines to the home setting.
          Cover page: Developmental and cultural perspectives on children's postoperative pain management at homeCreative Commons 'BY' version 4.0 license
          • Article
          • Peer Reviewed
          UC Irvine Previously Published Works (2015)

          Objectives

          The goal of this study was to compare pediatric complementary and alternative medicine (CAM) use and pediatric health care provider CAM referral as well as identify predictors of use and referral.

          Design

          Surveys were administered to 283 parents/caregivers of pediatric patients and 200 pediatric health care providers (HCP).

          Setting

          This study took place at the Children's Hospital of Orange County (CHOC Children's) in Orange, CA.

          Main outcome measures

          Caregivers and HCP were provided a list of 32 CAM interventions and asked to indicate which treatments their child had ever used or which they would consider using for their child and which treatments they had ever referred or which they would consider referring, respectively. The main outcome variables were the number and type of CAM therapies endorsed by participants.

          Results

          Providers referred the majority of CAM therapies significantly more often than patients used each therapy and more often than caregivers would consider each therapy for their child. In addition, children from families with higher incomes, whose parents were older and had more education, who were White, and whose primary language spoken at home was English were more likely to use CAM therapies, all p's<0.05. HCP CAM referral was not significantly predicted by number of years a health care provider practiced or health care profession, all p's<0.05.

          Conclusions

          HCP referred CAM therapies more often than parents reported use for their children. Findings may imply that parents/caregivers are underutilizing CAM therapies for their children. Potential barriers to CAM use in pediatric patients needs to be explored.
            Cover page: Differences in referral and use of complementary and alternative medicine between pediatric providers and patientsCreative Commons 'BY' version 4.0 license
            • Article
            • Peer Reviewed
            UC Irvine Previously Published Works (2023)
            Irritability is a term used to describe feelings of anger, annoyance and impatience, and is commonly experienced by individuals in daily life. However, there are diverse conceptualizations of irritability in public and clinical research, which often result in confusing irritability with anger and other overlapping concepts. This, in turn, leads to a lack of conceptual clarity. Accordingly, the purpose of this concept analysis was to explore the irritability concept, including its definitions, defining characteristics, antecedents, consequences and empirical referents. The findings showed that irritability is predominantly conceptualized as a psychophysiological concept in the literature. We demonstrated that irritability can be differentiated from overlapping concepts like anger by qualities, such as 'unpredictability and lowered emotion control', 'lowered threshold for negative emotional stimuli', 'being manifested in response to frustrative situations or physiological needs' and 'experience of disproportionate and unjustified emotional irritation'. Importantly, severe irritability prospectively predicts psychiatric disorders and greater impairments in health, financial, educational and social functioning in individuals. Taken together, our analysis showed that one should take into account the context, duration, intensity and importantly outcomes, when assessing irritability in an individual. Considering these findings and the presence of irritability in nursing practice, it is crucial for nurses to recognize and successfully identify this concept in the nursing care they provide within the diverse settings and patient populations.
              Creative Commons 'BY-NC' version 4.0 license
              • Article
              • Peer Reviewed
              UC Irvine Previously Published Works (2015)
              Millions of children undergo outpatient surgery in the United States each year; the overwhelming majority will experience significant perioperative anxiety and pain. Behavioral preparation programs focused on skills acquisition and modeling, considered essential for effective preparation, are no longer offered to most children and families in the outpatient surgery setting. Moreover, what little preparation does occur is typically generic in nature, rather than tailored to unique characteristics of the child and family. Untreated anxiety and pain have significant implications for children's short- and long-term recovery and future interactions in the medical environment. The rapid growth of the World Wide Web and increasing access to Internet by families across the country provide an opportunity to develop tailored, Web-based behavioral preparation programs that can be accessed repeatedly at times convenient to the child and family, that include coping skills training and modeling, and that can provide unique output based upon child and parent characteristics known to impact perioperative pain and anxiety. In this review article, we present a conceptual framework for a computer-based intervention that may transform the way we manage children and parents before and after surgery.
                Cover page: Treating perioperative anxiety and pain in children: a tailored and innovative approach
                • Article
                • Peer Reviewed
                UC Irvine Previously Published Works (2019)
                The topic of patient satisfaction has gained increasing importance over the past decade. Due to the impact of patient satisfaction on health care quality, understanding factors that predict satisfaction is vital. The purpose of this review is to examine the literature and identify factors related to patient perioperative satisfaction as well as predictive variables that, if modified, can enhance satisfaction scores of patients undergoing surgery. Our review reports that patient satisfaction scores are affected by modifiable factors such as clinician-patient communication, information provision to patients, and operational function of a hospital. Non-modifiable factors affecting patient satisfaction scores include patient demographics such as gender, age, and education. In order to enhance patient perioperative satisfaction, we suggest that anesthesiologists and surgeons focus their efforts on enhancing their communication skills and providing information that is appropriately tailored to the understanding of their patients.
                  Cover page: Primer on adult patient satisfaction in perioperative settings.Creative Commons 'BY' version 4.0 license
                  • Article
                  • Peer Reviewed
                  UC Irvine Previously Published Works (2019)
                  The topic of patient satisfaction has gained increasing importance over the past decade. Due to the impact of patient satisfaction on health care quality, understanding factors that predict satisfaction is vital. The purpose of this review is to examine the literature and identify factors related to patient perioperative satisfaction as well as predictive variables that, if modified, can enhance satisfaction scores of patients undergoing surgery. Our review reports that patient satisfaction scores are affected by modifiable factors such as clinician-patient communication, information provision to patients, and operational function of a hospital. Non-modifiable factors affecting patient satisfaction scores include patient demographics such as gender, age, and education. In order to enhance patient perioperative satisfaction, we suggest that anesthesiologists and surgeons focus their efforts on enhancing their communication skills and providing information that is appropriately tailored to the understanding of their patients.
                    Cover page: Primer on adult patient satisfaction in perioperative settingsCreative Commons 'BY' version 4.0 license
                    • Article
                    • Peer Reviewed
                    UC Irvine Previously Published Works (2015)

                    Background

                    As a result of cost-containment efforts, preparation programs for outpatient surgery are currently not available to the majority of children and parents. The recent dramatic growth in the Internet presents a unique opportunity to transform how children and their parents are prepared for surgery. In this article, we describe the development of a Web-based Tailored Intervention for Preparation of parents and children undergoing Surgery (WebTIPS).

                    Development of program

                    A multidisciplinary taskforce agreed that a Web-based tailored intervention consisting of intake, matrix, and output modules was the preferred approach. Next, the content of the various intake variables, the matrix logic, and the output content was developed. The output product has a parent component and a child component and is described in http://surgerywebtips.com/about.php. The child component makes use of preparation strategies such as information provision, modeling, play, and coping skills training. The parent component of WebTIPS includes strategies such as information provision, coping skills training, and relaxation and distraction techniques. A reputable animation and Web design company developed a secured Web-based product based on the above description.

                    Conclusions

                    In this article, we describe the development of a Web-based tailored preoperative preparation program that can be accessed by children and parents multiple times before and after surgery. A follow-up article in this issue of Anesthesia & Analgesia describes formative evaluation and preliminary efficacy testing of this Web-based tailored preoperative preparation program.
                      Cover page: Web-Based Tailored Intervention for Preparation of Parents and Children for Outpatient Surgery (WebTIPS)
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