Papers by Margaret Wallhagen
Encyclopedia of Behavioral Medicine, 2020
International Journal of Older People Nursing, 2020
In sub-Saharan Africa, the unique challenges facing its ageing populations have been attributed t... more In sub-Saharan Africa, the unique challenges facing its ageing populations have been attributed to the HIV epidemic. Approximately 35 million people in sub-Saharan Africa have died since the beginning of the HIV epidemic, while 23.5 million continue to live with the condition (UNAIDS, 2017). An estimated 28,000 of these deaths have occurred in Uganda, an East African nation with a population of only about 44.27 million people (Uganda Population, 2019). According to the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD)
Issues in Mental Health Nursing, 2019
Studies of caregiving provided to HIV/AIDS orphans by sub-Saharan African grandparents have found... more Studies of caregiving provided to HIV/AIDS orphans by sub-Saharan African grandparents have found that it has physical, financial, and emotional consequences. Our study extended this research by identifying and characterizing the symptoms experienced by Ugandan grandparent-caregivers, particularly as related to the caregiving role, loss and grief. Grounded theory methodology was used to conduct and analyze audio-recorded, semi-structured interviews with 32 grandparents. Findings revealed a cluster of biopsychosocial distress symptoms, especially anguish (driven by traumatic anxiety and disbelief), depression, and somatic symptoms that were linked primarily to psychological distress. The impact of cultural practices and beliefs on these symptoms was also identified. Results have implications for public health, research, and policy changes needed to alleviate symptoms of biopsychosocial distress among Uganda grandparent-caregivers. Background and significance Caring for a loved one may be stressful and could have adverse health outcomes for the caregiver. The experience of caring, or caregiving, has been studied in many contexts, but primarily in relation to the stress experienced when the caregiver and care recipient are either of the same generation or only a single generation apart (
Workplace health & safety, 2018
The purpose of this study was to assess occupational injury characteristics and predictors among ... more The purpose of this study was to assess occupational injury characteristics and predictors among career firefighters. A total of 249 firefighters from central Texas and northern California participated in this Internet-based survey. Approximately 27% of firefighters had reported an occupational injury within the previous 12 months. The majority of injuries occurred on the scene of a non-fire call while performing an activity that required lifting, pushing, or pulling. Firefighters' backs were most frequently injured. Of the reported injuries, approximately 18% returned to work on modified duty, but 46% were not allowed to work due to their occupational injuries. Firefighters who reported occupational injuries were more likely to be older and experiencing occupational stress compared with their coworkers who did not report occupational injuries. Injured firefighters were also more likely to report fewer job rewards (money/salary), overcommitment, less esteem (respect and support)...
Journal of Loss and Trauma, 2018
Despite increasing numbers of studies investigating grandparent-caregivers of children orphaned b... more Despite increasing numbers of studies investigating grandparent-caregivers of children orphaned by HIV/AIDS in sub-Saharan Africa, research on their mental and physical health remains inadequate. We provide a qualitative account of the nature, extent, and relationships among multiple variations of loss emerging from 32 interviews with Ugandan grandparent-caregivers of grandchildren affected by HIV/AIDS. Regardless the type or nature of the loss, participants expressed physical, emotional, and financial distress as a result. This cumulative loss and subsequent grief could potentially be associated with mental and physical health problems. Research to further explore the concept of loss among this vulnerable population is recommended.
JAMA otolaryngology-- head & neck surgery, Jan 8, 2018
Nearly 38 million individuals in the United States have untreated hearing loss, which is associat... more Nearly 38 million individuals in the United States have untreated hearing loss, which is associated with cognitive and functional decline. National initiatives to address hearing loss are currently under way. To determine whether untreated hearing loss is associated with increased health care cost and utilization on the basis of data from a claims database. Retrospective, propensity-matched cohort study of persons with and without untreated hearing loss based on claims for health services rendered between January 1, 1999, and December 31, 2016, from a large health insurance database. There were 154 414, 44 852, and 4728 participants at the 2-, 5-, and 10-year follow-up periods, respectively. The study was conceptualized and data were analyzed between September 2016 and November 2017. Untreated hearing loss (ie, hearing loss that has not been treated with hearing devices) was identified via claims measures. Medical costs, inpatient hospitalizations, total days hospitalized, 30-day ho...
Journal of the American Association of Nurse Practitioners, 2018
Drug-related ototoxicity may exacerbate presbycusis (age-related hearing loss); yet, few data are... more Drug-related ototoxicity may exacerbate presbycusis (age-related hearing loss); yet, few data are available on the prevalence of ototoxic medication use by older adults. The purposes of this study were to assess the impact of aging and ototoxicity on hearing loss, the prevalence of ototoxic medication use, and select characteristics associated with ototoxic medication use among older adults. Cross-sectional analyses were conducted using select variables extracted from the baseline and 10-year follow-up assessments of the two population-based epidemiological studies to compare two points in time. Ninety-one percent of the sample was taking a medication reported to be ototoxic. Nonsteroidal anti-inflammatory drugs were the most commonly used (75.2%), followed by acetaminophen (39.9%) and diuretics (35.6%). Hypertension, diabetes, cardiovascular disease, and history of smoking were associated with ototoxic medication use. Participants with hearing loss were taking a significantly great...
Journal of pain and symptom management, Jan 7, 2018
The most common adverse effects from neurotoxic chemotherapy are chemotherapy-induced neuropathy ... more The most common adverse effects from neurotoxic chemotherapy are chemotherapy-induced neuropathy (CIPN), hearing loss, and tinnitus. While associations between perceived stress and persistent pain, hearing loss, and tinnitus are documented, no studies have examined these associations in cancer survivors who received neurotoxic chemotherapy. In this cross-sectional study, we evaluated for associations between perceived stress and the occurrence of CIPN, hearing loss, and tinnitus, in 623 adult cancer survivors who received platinum and/or taxane compounds. Survivors completed self-report measures of hearing loss, tinnitus, and perceived stress (i.e., Impact of Events Scale-Revised (IES-R)). Separate logistic regression analyses were done for each neurotoxicity to evaluate whether each of the IES-R subscale (i.e., intrusion, avoidance, hyperarousal) and total scores made a significant independent contribution to neurotoxicity group membership. Of the 623 survivors in this study, 68.4%...
European journal of oncology nursing : the official journal of European Oncology Nursing Society, 2018
The purpose of this study was to evaluate for differences in demographic, clinical, and pain char... more The purpose of this study was to evaluate for differences in demographic, clinical, and pain characteristics, as well as measures of sensation, balance, perceived stress, symptom burden, and quality of life (QOL) among survivors who received neurotoxic chemotherapy (CTX) and who reported only chemotherapy-induced neuropathy (CIN, n = 217), CIN and hearing loss (CIN/HL, n = 69), or CIN, hearing loss, and tinnitus (CIN/HL/TIN, n = 85). We hypothesized that as the number of neurotoxicities increased, survivors would have worse outcomes. Survivors were recruited from throughout the San Francisco Bay area. Survivors completed self-report questionnaires for pain and other symptoms, stress and QOL. Objective measures were assessed at an in person visit. Compared to survivors with only CIN, survivors with all three neurotoxicities were less likely to be female and less likely to report child care responsibilities. In addition, survivors with all three neurtoxicities had higher worst pain sc...
Journal of cancer survivorship : research and practice, Jan 20, 2017
Limited information is available on the impact of chemotherapy (CTX)-induced neurotoxicity on adu... more Limited information is available on the impact of chemotherapy (CTX)-induced neurotoxicity on adult survivors' symptom experience and quality of life (QOL). Purposes were to describe occurrence of hearing loss and tinnitus and evaluate for differences in phenotypic characteristics and measures of sensation, balance, perceived stress, symptom burden, and QOL between survivors who received neurotoxic CTX and did (i.e., neurotoxicity group) and did not (i.e., no neurotoxicity group) develop neurotoxicity. Neurotoxicity was defined as the presence of chemotherapy-induced neuropathy (CIN), hearing loss, and tinnitus. Survivors in the no neurotoxicity group had none of these conditions. Survivors (n = 609) completed questionnaires that evaluated hearing loss, tinnitus, stress, symptoms, and QOL. Objective measures of sensation and balance were evaluated. Of the 609 survivors evaluated, 68.6% did and 31.4% did not have CIN. Of the survivors without CIN, 42.4% reported either hearing lo...
Journal of the American Board of Family Medicine : JABFM
Hearing deficits are highly prevalent among older adults and are associated with declines in cogn... more Hearing deficits are highly prevalent among older adults and are associated with declines in cognitive, physical, and mental health. However, hearing loss in the geriatric population often goes untreated and generally receives little clinical emphasis in primary care practice. This article reviews hearing health care for older adults, focusing on what is most relevant for family physicians. The objective of hearing loss treatment is to ensure that a patient can communicate effectively in all settings. We present the 5 major obstacles to obtaining effective hearing and rehabilitative care: awareness, access, treatment options, cost, and device effectiveness. Hearing technologies are discussed, along with recommendations on when it is appropriate to screen, refer, or counsel a patient. The purpose of this article is to provide pragmatic recommendations for the clinical management of the older adult with hearing loss that can be conducted in family medicine practices.
Schizophrenia Research, 2008
Results: Diagnosis and level of symptoms were found to predict the total QLS score (p<0.001 and 0... more Results: Diagnosis and level of symptoms were found to predict the total QLS score (p<0.001 and 0.003) across diagnostic groups, in contrast with objective cognitive performance and subjective cognitive complaint (p=0.76 and =0.09). A QLS score higher than 100 predicted a diagnosis of BD with high sensitivity (0.92) and specificity (0.73). Conclusions: These results suggest that clinical variables are more robust correlates of QLS scores than cognitive testing. The QLS achieved adequate convergent validity across diagnostic groups, which is in line with the current trend to reassess psychiatric nosology and functioning along dimensional constructs rather than mere diagnostic categories. References [1] Green MF, Cognitive impairment and functional outcome in schizophrenia and bipolar disorder. J Clin Psychiatry. 2006;67 [2] Suppl 9:3-8. [3] Heinrichs DW, et al. The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull. 1984;10(3):388-98. [4] Perlick DA, et al. Association of symptomatology and cognitive deficits to functional capacity in schizophrenia. Schizophr Res.
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2003
Although diabetes education encourages people to monitor symptoms of glycemic imbalance, there ha... more Although diabetes education encourages people to monitor symptoms of glycemic imbalance, there has been little research on how people from ethnic minorities recognize and understand their symptoms. To explore this question, semi-structured interviews were conducted with 23 African Americans over age 60 living with diabetes. Thematic analysis revealed 3 patterns of symptom experience. Those with prominent symptoms understood their body to be providing meaningful feedback on the diabetes and their efforts to manage the disease. Those with absent symptoms perceived no physical response to their diabetes, which they took to mean that the disease was well controlled. Those with perplexing symptoms could not interpret the messages they received from their body and were discouraged by this, often feeling they could not trust their body. The findings suggest that innovative strategies are needed to help people become more attuned to their body so they might better recognize and understand t...
Using the Japanese concept of ikigai, which describes a certain state of psychological well-being... more Using the Japanese concept of ikigai, which describes a certain state of psychological well-being, this study explores how Japanese family caregivers of elderly parents with dementia pursue, maintain, or attempt to regain their psychological well-being in the face of the hardship of caregiving. Using constant comparative methodology, twenty-six Japanese women who were caring for an elderly demented parent or parent-in-law were interviewed. Based on the analysis of interview data, we define ikigai as certain life experiences and/or the positive emotion felt through those experiences that allow the caregiver to judge her life as good and meaningful, and to feel that it is worthwhile to continue living. Caregivers use various different means to pursue their ikigai depending on the context of care. The types of their pursuit of ikigai are examined in varying contexts of caregiving. Because the data suggest that ikigai experience influences how the caregivers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; self-understanding changes over time, the notion of ikigai is further explored in relation to the construct of self-understanding.
Care of the elderly in Botswana is solely a family responsibility. In the absence of formal progr... more Care of the elderly in Botswana is solely a family responsibility. In the absence of formal programs for the elderly it is important to understand the cultural beliefs that guide decision making regarding acceptance of elderly care. The purpose of this study was to explore the experiences of family caregivers to older persons in Botswana. Using grounded theory methodology, 24 caregivers who were caring for an older person were interviewed. The findings indicate that the perceptions that guided the caregivers&amp;amp;amp;amp;amp;amp;#39; decision making process of acceptance or non-acceptance of assistance from both family members and the government fell into three inter-related but distinct categories: Stigma, Appropriate-inappropriate forms of care; and Sense of Place. It is recommended that cultural sensitivity should be considered in designing models of support for families who are looking after their older relatives. Finally, a clear understanding of the perceptions of family members&amp;amp;amp;amp;amp;amp;#39; needs must be emphasized as these differ from health workers&amp;amp;amp;amp;amp;amp;#39; perceptions of family needs.
The Diabetes Educator, 2010
Purpose To explore the relationship between the symptoms of schizophrenia experienced by older pe... more Purpose To explore the relationship between the symptoms of schizophrenia experienced by older persons diagnosed with schizophrenia and type 2 diabetes mellitus and their response to a health promoting intervention. Methods Secondary data analysis of data obtained from a lifestyle intervention program that recruited participants over age 40 with schizophrenia or schizoaffective disorder and type 2 diabetes mellitus from board-and-care facilities and day treatment programs. Participants had been randomly assigned to a 24-week diabetes awareness and rehabilitation training (DART; n = 32) or a usual care plus information (UCI; n = 32) comparison group. Baseline and 6-month (intervention completion) assessments included a diabetes knowledge test (DKT), diabetes self-efficacy measured by the diabetes empowerment scale (DES), and symptomatology defined by the Positive and Negative Syndrome Scale (PANSS). Simple linear regression models in 3 steps were used to analyze the data. Results A s...
Scandinavian Journal of Caring Sciences, 2005
Nursing as a caring practice from a phenomenological perspective Nursing is frequently described ... more Nursing as a caring practice from a phenomenological perspective Nursing is frequently described as a caring practice. What this concept means may be less clear. This paper considers nursing as a caring practice in three steps. First, the concept of practice based on Taylor's and MacIntyre's philosophical definitions of the term is described. Secondly, numerous notions of caring are presented; the call from some nurse researchers for quantification of the concept and why this is problematic is discussed; and an exposition of caring from a phenomenological perspective is provided. Finally, the notions of practice and caring are joined, and the concept of a caring practice is presented. Nursing as a public caring practice is illustrated with examples from an interpretive phenomenological study. In conclusion, it is claimed that a phenomenological view of caring combined with a comprehensive definition of practice is well suited to nursing, and allows for a description of nurses' caring practices from both a nursing and patient perspective.
Pain, 1997
The purposes of this study were to determine if there were differences in pain intensity scores, ... more The purposes of this study were to determine if there were differences in pain intensity scores, pain duration scores, mood states, and quality of life of oncology outpatients whose pain intensity scores were congruent with their family caregivers compared to patients whose pain intensity scores were non-congruent and to determine if there were differences in mood states, health status, and caregiver strain between family caregivers whose pain intensity scores were congruent with their family members and those family caregivers whose pain intensity scores were non-congruent. A total of 78 patient-caregiver dyads participated in the study. Patients completed a Demographic Questionnaire, a Cancer Pain Questionnaire, the Profile of Mood States, and the Multidimensional Quality of Life Scale-Cancer 2. Family caregivers completed a demographic questionnaire, the Profile of Mood States, the Caregiver Strain Index, and the Medical Outcome Study Short-Form Health Survey. Both patients and family caregivers rated the patient's pain intensity using a visual analogue scale (VAS). Patients in the non-congruent dyads (i.e. difference of Ͼ10 on the VAS score) had significantly more mood disturbance and a poorer quality of life than patients in the congruent dyads. Family caregivers in the non-congruent dyads had significantly higher caregiver strain score than caregivers in the congruent dyads. These findings suggest that differences in the perception of the pain experience between patients and their family caregivers is associated with deleterious outcomes for the patient and their family caregivers.
The Nurse Practitioner, 1999
Lower-extremity amputation is a much feared complication of diabetes mellitus; however, 40% to 50... more Lower-extremity amputation is a much feared complication of diabetes mellitus; however, 40% to 50% of these amputations are preventable. Peripheral neuropathy has been implicated as a cause in some 82% of diabetic amputations. Patient education on foot care is often not enough to prevent foot ulceration and potential amputation. Health care providers can lower the incidence of lower extremity amputation by using a Semmes-Weinstein monofilament to identify protective sensation loss and quickly taking measures to prevent ulceration. Diabetes patients who have a history of foot deformity, ulceration, or amputation of any part of the foot should be referred for special shoes or orthotics. This article reviews the methods for identifying those patients with diabetes that are at high risk for amputation and preventive interventions.
Journal of Transcultural Nursing, 2006
This study explores how cultural values affect the meaning and experiences of daughter (or daught... more This study explores how cultural values affect the meaning and experiences of daughter (or daughter-in-law) caregivers of elderly persons with dementia by comparing caregivers in the United States and Japan. Nine American and seven Japanese caregivers were interviewed twice at 6-month intervals. Interviews were audiotaped and analyzed using constant-comparative techniques. Data suggest that moral obligation to care and intense loss are two universal themes of caregiving. However the experiences and perceptions of the role of caregivers from these two cultures differed in select ways that were captured within three categories: reasons for caregiving, caregiving as a career, and caregiving as a life phase or detour. Findings suggest that American caregivers may need greater anticipatory socialization regarding the caregiving role, whereas Japanese caregivers may benefit from assistance in accepting needed services.
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Papers by Margaret Wallhagen