Debra J. Barksdale

Allostasis and allostatic load: expanding the discourse on stress and cardiovascular disease

AIM The aim of this discursive paper is to introduce allostasis and allostatic load, which are relatively new concepts proposed to explain physiological responses to stress, and to suggest ways in which allostasis theory can be applied to the development of clinical interventions to increase resilience for producing better health outcome. BACKGROUND Common explanations of stress have failed adequately to explicate its association with health and chronic illness. Allostasis is the extension of the concept of homeostasis and represents the adaptation process of the complex physiological system to physical, psychosocial and environmental challenges or stress. Allostatic load is the long-term result of failed adaptation or allostasis, resulting in pathology and chronic illness. DISCUSSION The concepts of allostasis and allostatic load introduced the idea that external challenges initiate allostasis and chronic stress causes allostatic load that can be measured with multiple biomarkers. Finding from several studies suggests that higher allostatic load is associated with worse health outcomes. Resilience represents successful allostasis and strategies can be implemented to enhance resilience and thereby improve health outcomes. CONCLUSIONS This theoretical model provides a comprehensive explanation of the human bodys adaptation processes in response to stress and the results of failed adaptation over time. In addition, combining the concepts of allostasis and resilience may help us to understand and implement clinical strategies better to reduce or prevent the debilitating physiological and psychological effects of chronic stress and chronic illness. RELEVANCE TO CLINICAL PRACTICE Clinical practice should be based on a solid theoretical foundation to improve health outcomes. Strategies to manage stress and increase resilience along with clinical interventions to manage the physiological responses to chronic stress are necessary to assist in preventing and controlling the detrimental effects of chronic disease on human life.

Barriers to health care and health-seeking behaviors faced by Black men

PurposeTo describe unique barriers to health care and health-seeking behaviors faced by Black men and to make recommendations to healthcare providers for improving healthcare access for Black men. Data sourcesA PubMed search for research articles published after 1999 was conducted. ConclusionsThe articles selected for this state of the science clinical paper addressed barriers to access faced by Black men and/or management strategies used to mitigate barriers and improve access. The barriers identified include socioeconomic status, masculinity, racism, lack of awareness of the need for primary care, religious beliefs, and peer influences. As singular entities, these may not appear unique, but when viewed collectively, they represent an overwhelming constellation of obstacles for Black men. Implications for practiceIndividual, community, state, and national level recommendations for nurse practitioner actions to improve healthcare access for Black men include public service announcements, radio commercials, and billboards aimed at raising awareness of healthcare issues in the Black community, provision of preventive services through health fairs, and development of positive provider–patient relationships.

Racial Discrimination and Blood Pressure: Perceptions, Emotions, and Behaviors of Black American Adults

This study examined racial discrimination and blood pressure (BP) in 211 Black Americans. Racial discrimination is a chronic stressor for many Black Americans and hypertension prevalence is high in this population. Secondary analyses of data from the study, “Everyday Life for Black American Adults,” were conducted to examine relationships among perceived racial discrimination, emotional and behavioral responses to racism, and BP. Although racial discrimination was not correlated with BP, sadness and frustration were significantly but negatively correlated with BP. Speaking out and prayer were frequent behavioral responses to racism. Findings should sensitize healthcare providers to the effects of racial discrimination on the health of Black Americans.

The Effect of Anxiety and Depression on Symptoms Attributed to Atrial Fibrillation

Symptoms attributed to atrial fibrillation (AF) are nonspecific, and it remains unclear what influences perception of symptoms. Anxiety or depression may be important in modulating perception of AF symptoms. However, few longitudinal studies have addressed this effect.

The Patient-Centered Outcomes Research Institute (PCORI): Information for academic nursing

As part of the Patient Protection and Affordable Care Act of 2010, the U.S. Congress created the Patient-Centered Outcomes Research Institute (PCORI). Its goal is to fund research that will assist patients, caregivers, clinicians, and others in making informed health decisions. Because nurses play a critical role in engaging patients in health care, they are valued participants in setting the institutes agenda and carrying out its programs. In this article, we provide an overview of PCORI and describe how nurses can participate in institute activities and apply for research grants.

The Patient-Centered Outcomes Research Institute: Research Done Differently

BackgroundThe Patient-Centered Outcomes Research Institute (PCORI) was authorized by the Patient Protection and Affordable Care Act of 2010 to fund comparative clinical effectiveness research to provide reliable evidence to help patients and their healthcare providers make informed decisions. ObjectiveThe aim of this paper is to describe the synergy between nursing research and PCORI funding priorities, discuss unique aspects of PCORI funding, and identify the implications for nurse researchers. DiscussionGoals of nursing research are well aligned with PCORI interests. Given this synergy, many phenomena that nursing scientists study could become topics of a competitive proposal for PCORI funding. Major aspects of PCORI funding with implications for nurse researchers include the nature of the questions asked, funding priorities, engagement of patients and stakeholders, compliance with the PCORI’s methodology standards, and the proposal review criteria and process.

Morning blood pressure surge and nighttime blood pressure in relation to nocturnal sleep pattern and arterial stiffness.

Objective:The phenomenon of morning blood pressure (BP) surge (MBPS) is known to increase the risk for cardiovascular events and stroke. The purposes of this study were to explore associations between MBPS and nighttime BP and to examine arterial stiffness and sleep pattern in association with MBPS. Methods:This study included 30 healthy Korean American women aged 25 to 60 years. Ambulatory BP was monitored for 24 hours. To evaluate MBPS, maximum morning BPpower was calculated. Arterial stiffness was measured by carotid-femoral pulse wave velocity, and sleep pattern was evaluated using an actigraphy. Results:The participants (n = 8) in the upper quartile of MBPS had higher morning systolic BPs (SBPs; P = 0.015) and lower nighttime diastolic BPs (P = 0.031). The MBPS in SBP was significantly increased in the participants who had a more wakeful night (P = 0.038) and who slept longer at night (P = 0.041). Although MBPS was not significantly related to arterial stiffness, higher morning SBP (P = 0.005), morning diastolic BP (P = 0.048), and prewake SBP (P = 0.005) were associated with arterial stiffness. Conclusions:Our findings imply a possible link between disturbed sleep and MBPS. Clinicians should understand the importance of the modification of altered sleep pattern for reducing MBPS in nonhypertensive participants.

Psychological stress and arterial stiffness in Korean Americans

OBJECTIVE Arterial stiffness is identified as a causative factor for hypertension. The purpose of this study was to explore the relationship between psychological stress and arterial stiffness in Korean Americans. METHODS A convenience sample of 102 Korean Americans (aged 21-60 years, 60% women) was recruited from North Carolina. Psychological stress was measured by the Perceived Stress Scale, the Social, Attitudinal, Familiar, and Environmental (SAFE) Acculturative Stress Scale, and the Spielbergers State-Trait Anxiety Inventory. Arterial stiffness was measured by carotid-femoral pulse wave velocity (cfPWV) using the SphygmoCor system (AtCor Medical, Australia). RESULTS This study shows that the emotional stress response, measured by anxiety, significantly predicted arterial stiffness (β=.25, p=.008), independently of such confounding factors as age, mean arterial pressure (MAP), gender, body mass index, smoking, education, and income. Anxiety was neither related to age (r=.12, p=.212) nor MAP (r=.14, p=.151). Additionally, this sample of Korean Americans had higher levels of psychological stress when compared to previous findings from studies of other racial/ethnic groups in the U.S. CONCLUSION Findings demonstrate that anxiety is a significant and independent determinant of arterial stiffness. Given that anxiety was not related to MAP, these findings suggest that arterial stiffness may be a pathway to explain the connection between anxiety and hypertension risk. Studies that scrutinize the relationship between anxiety and arterial stiffness are an important next step for future research. Further studies are also recommended to explore cultural factors and individual characteristics that may affect anxiety in Korean Americans.

Faculty development: doing more with less.

Faculty development is essential to prepare novice nurse educators for their teaching role and to keep experienced faculty up to date with new educational approaches. This article describes a comprehensive and cost-effective program for faculty development that builds on the expertise of current faculty to educate, guide, and support colleagues, and foster their career development. The faculty development program includes an annual clinical faculty workshop; monthly face-to-face and online educational programs; a formal mentoring program for novice teachers and faculty members new to the school; programs for professional and career development; and a website for faculty orientation and continued learning.

Relationships among acculturative stress, sleep, and nondipping blood pressure in Korean American women.

Generally blood pressure (BP) should drop or dip by 10–20% during sleep. The phenomenon of nondipping BP during sleep has gained interest because of its association with various damaging effects to end-organs. This exploratory study examined nighttime nondipping BP, acculturative stress and quality of sleep in 30 Korean American women. Acculturative stress and sleep quality were measured using the Revised Social, Attitudinal, Familial, and Environmental Acculturative Stress Scale (R-SAFE) and the Pittsburg Sleep Quality Index (PSQI), respectively. Participants’ BP was monitored over a 24-hour period. Participants were categorized as dippers and nondippers based on the drop in nocturnal systolic BP. Of the 30 women, 8 (26.7%) were nondippers. A shorter sleep duration and more disturbed sleep were associated with nondipping and, interestingly, less acculturative stress was also associated with nondipping BP. Our finding supports that sleep evaluation is needed in caring for individuals with nondipping BP.