PHD, Kent State University, 2017, College of Nursing
A PATH ANALYSIS OF TRUST IN NURSES, SOCIAL SUPPORT, PATIENT SELF-ADVOCACY, PSYCHOLOGICAL DISTRESS, AND PHYSICAL SYMPTOMS IN PATIENTS WITH CHRONIC HEART FAILURE (199 pp.)
Director of Dissertation: Ratchneewan Ross, Ph.D., RN, FAAN
Patients with heart failure participate in care by self-advocating, or speaking up, to their health care providers. By gaining and using health information, assertively communicating, and making decisions, patients are self-advocating. A cross-sectional, path analysis design was used to test two structural models. A convenience sample of 80 HF clinic patients were surveyed using the Adapted Patient Self-Advocacy Scale, Health Care Relational Trust in Clinic Nurses Scale, Medical Outcome Study Social Support Scale, Hospital Anxiety and Depression Scale, and the Symptom Status Questionnaire for Heart Failure.
An analysis was conducted to test the direct and indirect effects of trust in nurses, social support, and self-advocacy, on psychological distress and physical symptoms. Two structural models were created; neither model fit the data as hypothesized. A respecified model focusing on the components of self-advocacy was tested, trimmed, and found to fit the data (chi square 9.452, df 6, p .105; RMSEA .085; CFI .877, IFI .892, NFI .752). Trust in nurses directly affected patient self-advocacy knowledge (beta .25, R2 .06, p .05). Social support directly affected patient assertiveness (beta .26, R2 .07, p .05). And social support directly affected depressive symptoms (beta-.40, R2 .16, p .001). Nursing plays a role in patient self-advocacy. Educating and encouraging patients to use acquired knowledge in decision making supports patient participation and self-advocacy. Nursing's encouragement of the supportive role of friends and family members can have a positive influence on patient assertiveness and depressive symptoms.
Committee: Ratchneewan Ross Ph.D., R.N., F.A.A.N. (Committee Chair); Patricia Vermeersch Ph.D., C.N.P., R.N. (Committee Member); Marlene Huff Ph.D., M.S.N., C.N.S. (Committee Member); Joel Hughes Ph.D. (Committee Member); Richard Adams Ph.D. (Committee Member)
Subjects: Communication; Nursing