This manuscript option dissertation elucidates the role of patient-provider interactions in keeping HIV positive Black women in medical care. Since 2012, the Arizona State Department of Health has acknowledged that women of African descent are disproportionately affected by HIV and die at higher rates from AIDS-related complications than other women. The dissertation includes three manuscripts covering a feature of this topic. The first paper is a scoping review of literature on what is known about the influence of patient-provider relationships on adherence and viral suppression among Black women living with HIV in Arizona. The second is an empirical study built upon interviews with Black women living with HIV analyzed through constructivist grounded theory to understand women’s perspectives of provider actions that keep them in care. The third offers practice recommendations based on the interviews with Black women living with HIV, dialog with HIV advocates, and proceedings of the Phoenix Fast Track Cities ad hoc committee to end HIV as an epidemic. Together, the three manuscripts integrate the voices of women, advocates, and past research to support best practices and future steps for HIV retention strategies.

Personal hygiene, as well as many other daily living tasks, is not often regarded as a stressful or traumatic event. Giving a bath or shower to a person with Alzheimer’s disease or related dementias (ADRD) is typically an ongoing struggle for caregivers around the world. Generally, taking a bath or shower results in hostility, arguing, combativeness, screaming and even crying. This study explores claims that live music decreases levels of stress during bathing for people with ADRD. To test this, qualitative data has been collected based on the observations of professional caregivers, and quantitative data has been collected based on the levels of cortisol, a human stress hormone, taken before and after bath times on music and non-music days. These preliminary results suggest that live music-based interventions may lessen the trauma experienced by the residents during bath times. Therefore, this study opens the door for more consistent use of music by nurses, nursing aids, and other caregivers to perform better care for people with memory-loss complications.

Background: Heart failure is the leading cause of hospitalization in older adults and has the highest 30-day readmission rate of all diagnoses. An estimated 30 to 60 percent of older adults lose some degree of physical function in the course of an acute hospital stay. Few studies have addressed the role of posture and mobility in contributing to, or improving, physical function in older hospitalized adults. No study to date that we are aware of has addressed this in the older heart failure population.

Purpose: To investigate the predictive value of mobility during a hospital stay and patterns of mobility during the month following discharge on hospital readmission and 30-day changes in functional status in older heart failure patients.

Methods: This was a prospective observational study of 21 older (ages 60+) patients admitted with a primary diagnosis of heart failure. Patients wore two inclinometric accelerometers (rib area and thigh) to record posture and an accelerometer placed at the ankle to record ambulatory activity. Patients wore all sensors continuously during hospitalization and the ankle accelerometer for 30 days after hospital discharge. Function was assessed in all patients the day after hospital discharge and again at 30 days post-discharge.

Results: Five patients (23.8%) were readmitted within the 30 day post-discharge period. None of the hospital or post-discharge mobility measures were associated with readmission after adjustment for covariates. Higher percent lying time in the hospital was associated with slower Timed Up and Go (TUG) time (b = .08, p = .01) and poorer hand grip strength (b = -13.94, p = .02) at 30 days post-discharge. Higher daily stepping activity during the 30 day post-discharge period was marginally associated with improvements in SPPB scores at 30 days (b = <.001, p = .06).

Conclusion: For older heart failure patients, increased time lying while hospitalized is associated with slower walking time and poor hand grip strength 30 days after discharge. Higher daily stepping after discharge may be associated with improvements in physical function at 30 days.

The purpose of this study is to identify the needs of older adults with Alzheimer's disease (AD) and related dementias (ADRD) admitted to a rehabilitation setting where they are expected to physically and mentally function to their optimal level of health. To date, no studies have identified the needs and concerns of ADRD patients in rehabilitation settings. The Needs-Driven Dementia-Compromised Behavior (NDB) Model, the researcher's clinical experience, and the state of the current scientific literature will help guide the study. An exploratory qualitative research approach was employed to gather data and discover new information about the ADRD patient's needs and related behavioral outcomes. The qualitative findings on the discrepancies and similarities in perceptions of ADRD patient needs were obtained by examining formal and informal caregivers' perceptions. The researcher recruited registered nurses and certified nurse assistants (RNs and CNAs, formal) and family/friends (informal) who have provided care to patients in inpatient rehabilitation facilities to participate in focus groups and individualized focused interviews. The data were collated and analyzed using a thematic analysis approach. The overarching theme that developed as a result of this approach revealed discordant perceptions and expectations of ADRD patients' needs between the formal and informal caregivers with six subthemes: communication and information, family involvement, rehabilitation nurse philosophy, nursing care, belonging, and patient outcomes. The researcher provided recommendations to help support these needs. These findings will help guide the development of nurse-lead interventions for ADRD patients in a rehabilitation setting.