Skip to main content
eScholarship
Open Access Publications from the University of California

Scholarly Works (11 results)

  • Thesis
  • Peer Reviewed
UC Irvine Electronic Theses and Dissertations (2023)

Infant neonatal intensive care unit (NICU) hospitalization is known to increase maternal risk for psychological distress, including symptoms of post-traumatic stress disorder (PTSD). However, no universal screening standard has been established and predicting maternal risk remains challenging. While the psychosocial support needs of individual mothers are likely complex and may vary from family to family, reconceptualizing maternal distress in relation to differences between parenting expectations and NICU experiences may illuminate commonalities across a range of experiences. This mixed methods study explored parenting expectation-experience differences (EEDs) among NICU mothers and assessed correlations between mothers’ EED scores and psychological outcomes 1 – 5 years post-NICU hospitalization. A 3-phase explanatory sequential mixed methods design was employed. In Phase one, Pearson’s correlation coefficients were used to measure relationships between EED scores and maternal psychological outcomes (n = 128). Significant inverse correlations in the mild to moderate range were found between EED scores and maternal psychological outcomes (r = -0.25 to -0.41). In Phase two, reflexive thematic analysis of one-on-one, semi-structured interviews contextualized EED scores (n = 13). In Phase three, quantitative-qualitative data synthesis contextualized EED scores and revealed key differences in meaning ascribed to unmet parenting expectations.

Subsequent focused analysis of cross-sectional questionnaire data (n = 128) tested the association between EED scores and maternal PTSD symptoms using multiple linear regression. The moderating role of parenting self-efficacy was also examined. After adjusting for eight significant covariates in the main effects model, a negative association was found between EED scores and PTSD symptoms (B = -1.5, p < 0.001). Perceived parenting self-efficacy was found to moderate (weaken) this association (B = -0.141, p = 0.015).

Subsequent focused analysis of qualitative interview data (n = 13) explored needs identified by mothers of NICU-hospitalized children in relation to the principles of Trauma-Informed Care (TIC). Mothers’ care needs were found to align with TIC principles.

Findings suggest that interventions and NICU care practices aimed at better aligning parents’ expectations with NICU experiences and at promoting parenting self-efficacy among NICU mothers may improve delivery of supportive NICU care and suggest that implementation of TIC principles in NICU settings may support parental presence, participation in infant care, and mental health.

    • Article
    • Peer Reviewed
    UC Irvine Previously Published Works (2023)
      Cover page: Health Equity, Diversity, and Inclusion: Fundamental Considerations for Improving Patient CareCreative Commons 'BY' version 4.0 license
      • Article
      • Peer Reviewed
      UC Irvine Previously Published Works (2021)
        Cover page: How an effective response to post‐acute sequelae of SARS‐CoV‐2 infection (PASC) relies on nursing researchCreative Commons 'BY' version 4.0 license
        • Thesis
        • Peer Reviewed
        UC Irvine Electronic Theses and Dissertations (2022)

        Early in the Coronavirus disease-2019 (COVID-19) pandemic, frontline clinicians provided anecdotal observations there was an increase in the number of individuals presenting with a stroke who did not have traditional stroke factors. Current tools to evaluate stroke risks are based on decades of research-all conducted prior to COVID-19 pandemic and before the SARS-CoV-2 was in existence or circulating widely. Accurate stroke assessment is predicated on accurate identification of stroke risk factors. Little attention has been paid to re-examining stroke risk tools to consider the influence of COVID-19. This Quality Improvement (QI) project aimed to answer the question: Do established stroke tools capture factors that increase stroke risk during COVID and post-COVID illness? First, a review of literature was conducted to identify stroke risk assessment tools. Second, emerging risk factors for stroke related to COVID-19 were extracted from a literature search. Third, a survey, which included traditional and non-traditional risk factors found in the literature review, was developed and administered to 35 front-line clinical experts; this survey aimed to understand the reliability and content validity of stroke risk factors as they occur within the context of COVID-19. The clinical experts identified 23 traditional and 29 non-traditional risk factors as being highly associated with increased odds of stroke. The top traditional risk factors were atrial fibrillation, smoking (current or history), 2nd TIA in less than seven days, age >74, hypertension (>140/90 mmHg or SBP >140 or DBP >90). Non-traditional risk factors were metabolic syndrome, ipsilateral >50% carotid stenosis of the internal carotid artery and/or major cerebral artery, active COVID-19 infection that has lasted more than eight days, D-dimer >920 ng/m, and C-reactive protein >10.0 mg/L. This project provides a foundation for future QI projects and research with the goal of reducing risk for stroke within the context of COVID-19.

          Cover page: Understanding Risk for Stroke Within the Context of COVID-19
          • Article
          • Peer Reviewed
          UC Irvine Previously Published Works (2022)
          Postacute sequelae of SARS-CoV2 (PASC) infection is an emerging global health crisis, variably affecting millions worldwide. PASC has no established treatment. We describe 2 cases of PASC in response to opportune administration of over-the-counter antihistamines, with significant improvement in symptoms and ability to perform activities of daily living. Future studies are warranted to understand the potential role of histamine in the pathogenesis of PASC and explore the clinical benefits of antihistamines in the treatment of PASC.
            Cover page: Antihistamines for Postacute Sequelae of SARS-CoV-2 Infection.Creative Commons 'BY' version 4.0 license
            • Article
            • Peer Reviewed
            UC Irvine Previously Published Works (2022)
            Post-acute sequelae of SARS-CoV-2 (PASC) is defined as persistent symptoms after apparent recovery from acute COVID-19 infection, also known as COVID-19 long-haul. We performed a retrospective review of electronic health records (EHR) from the University of California COvid Research Data Set (UC CORDS), a de-identified EHR of PCR-confirmed SARS-CoV-2-positive patients in California. The purposes were to (1) describe the prevalence of PASC, (2) describe COVID-19 symptoms and symptom clusters, and (3) identify risk factors for PASC. Data were subjected to non-negative matrix factorization to identify symptom clusters, and a predictive model of PASC was developed. PASC prevalence was 11% (277/2,153), and of these patients, 66% (183/277) were considered asymptomatic at days 0-30. Five PASC symptom clusters emerged and specific symptoms at days 0-30 were associated with PASC. Women were more likely than men to develop PASC, with all age groups and ethnicities represented. PASC is a public health priority.
              Cover page: COVID Symptoms, Symptom Clusters, and Predictors for Becoming a Long-Hauler Looking for Clarity in the Haze of the Pandemic.Creative Commons 'BY' version 4.0 license
              • Article
              • Peer Reviewed
              UC Irvine Previously Published Works (2022)

              Aim

              This paper proposes a novel, trauma-informed, conceptual model of care for Post-Acute Sequelae of COVID-19 illness (PASC).

              Design

              This paper describes essential elements, linkages and dimensions of the model that affect PASC patient experiences and the potential impact of trauma-informed care on outcomes.

              Data sources

              PASC is a consequence of the global pandemic, and a new disease of which little is known. Our model was derived from the limited available studies, expert clinical experience specific to PASC survivors and publicly available social media narratives authored by PASC survivors.

              Implications for nursing

              The model provides a critical and novel framework for the understanding and care of persons affected by PASC. This model is aimed at the provision of nursing care, with the intention of reducing the traumatic impacts of the uncertain course of this disease, a lack of defined treatment options and difficulties in seeking care. The use of a trauma-informed care approach to PASC patients can enhance nurses' ability to remediate and ameliorate both the traumatic burden of and the symptoms and experience of the illness.

              Conclusion

              Applying a trauma-informed perspective to care of PASC patients can help to reduce the overall burden of this complex condition. Owing to the fundamentally holistic perspective of the nursing profession, nurses are best positioned to implement care that addresses multiple facets of the PASC experience.

              Impact

              The proposed model specifically addresses the myriad ways in which PASC may affect physical as well as mental and psychosocial dimensions of health. The model particularly seeks to suggest means of supporting patients who have already experienced a life-threatening illness and are now coping with its long-term impact. Since the scope of this impact is not yet defined, trauma-informed care for PASC patients is likely to reduce the overall health and systems burdens of this complex condition.
                Cover page: A novel conceptual model of trauma‐informed care for patients with post‐acute sequelae of SARS‐CoV‐2 illness (PASC)
                • Article
                • Peer Reviewed
                UC San Diego Previously Published Works (2024)

                Objective

                To determine the effect of SARS-CoV-2 variants on non-respiratory features of COVID-19 in vaccinated and not fully vaccinated patients using a University of California database.

                Methods

                A longitudinal retrospective review of medical records (n = 63,454) from 1/1/2020-4/26/2022 using the UCCORDS database was performed to compare non-respiratory features, vaccination status, and mortality between variants. Chi-square tests were used to study the relationship between categorical variables using a contingency matrix.

                Results

                Fever was the most common feature across all variants. Fever was significantly higher in not fully vaccinated during the Delta and Omicron waves (p = 0.001; p = 0.001). Cardiac features were statistically higher in not fully vaccinated during Omicron; tachycardia was only a feature of not fully vaccinated during Delta and Omicron; diabetes and GI reflux were features of all variants regardless of vaccine status. Odds of death were significantly increased among those not fully vaccinated in the Delta and Omicron variants (Delta OR: 1.64, p = 0.052; Omicron OR: 1.96, p < 0.01). Vaccination was associated with a decrease in the frequency of non-respiratory features.

                Conclusions

                Risk of non-respiratory features of COVID-19 is statistically higher in those not fully vaccinated across all variants. Risk of death and correlation with vaccination status varied.
                  Cover page: The effect of SARS-COV-2 variant on non-respiratory features and mortality among vaccinated and non-fully vaccinated patients
                  • Article
                  • Peer Reviewed
                  UC Irvine Previously Published Works (2022)
                  Long-haul COVID-19, also called post-acute sequelae of SARS-CoV-2 (PASC), is a new illness caused by SARS-CoV-2 infection and characterized by the persistence of symptoms. The purpose of this cross-sectional study was to identify a distinct and significant temporal pattern of PASC symptoms (symptom type and onset) among a nationwide sample of PASC survivors (n = 5652). The sample was randomly sorted into two independent samples for exploratory (EFA) and confirmatory factor analyses (CFA). Five factors emerged from the EFA: (1) cold and flu-like symptoms, (2) change in smell and/or taste, (3) dyspnea and chest pain, (4) cognitive and visual problems, and (5) cardiac symptoms. The CFA had excellent model fit (x2 = 513.721, df = 207, p < 0.01, TLI = 0.952, CFI = 0.964, RMSEA = 0.024). These findings demonstrate a novel symptom pattern for PASC. These findings can enable nurses in the identification of at-risk patients and facilitate early, systematic symptom management strategies for PASC.
                    Cover page: A distinct symptom pattern emerges for COVID-19 long-haul: a nationwide studyCreative Commons 'BY' version 4.0 license
                    • Article
                    • Peer Reviewed
                    UC Irvine Previously Published Works (2022)

                    Aims and objectives

                    To determine the frequency, timing, and duration of post-acute sequelae of SARS-CoV-2 infection (PASC) and their impact on health and function.

                    Background

                    Post-acute sequelae of SARS-CoV-2 infection is an emerging major public health problem that is poorly understood and has no current treatment or cure. PASC is a new syndrome that has yet to be fully clinically characterised.

                    Design

                    Descriptive cross-sectional survey (n = 5163) was conducted from online COVID-19 survivor support groups who reported symptoms for more than 21 days following SARS-CoV-2 infection.

                    Methods

                    Participants reported background demographics and the date and method of their covid diagnosis, as well as all symptoms experienced since onset of covid in terms of the symptom start date, duration, and Likert scales measuring three symptom-specific health impacts: pain and discomfort, work impairment, and social impairment. Descriptive statistics and measures of central tendencies were computed for participant demographics and symptom data.

                    Results

                    Participants reported experiencing a mean of 21 symptoms (range 1-93); fatigue (79.0%), headache (55.3%), shortness of breath (55.3%) and difficulty concentrating (53.6%) were the most common. Symptoms often remitted and relapsed for extended periods of time (duration M = 112 days), longest lasting symptoms included the inability to exercise (M = 106.5 days), fatigue (M = 101.7 days) and difficulty concentrating, associated with memory impairment (M = 101.1 days). Participants reported extreme pressure at the base of the head, syncope, sharp or sudden chest pain, and "brain pressure" among the most distressing and impacting daily life.

                    Conclusions

                    Post-acute sequelae of SARS-CoV-2 infection can be characterised by a wide range of symptoms, many of which cause moderate-to-severe distress and can hinder survivors' overall well-being.

                    Relevance to clinical practice

                    This study advances our understanding of the symptoms of PASC and their health impacts.
                      Cover page: The other COVID-19 survivors: Timing, duration, and health impact of post-acute sequelae of SARS-CoV-2 infection.Creative Commons 'BY' version 4.0 license
                      Top