self-transcendence in the context of hiv and alcohol
TRANSCRIPT
HIV
HIV is a life-long disease, affecting over 1.2 million people
in the United States and almost 14% are unaware of their
infection status
Sources are found in main article: Wikipedia:Hiv#Acute_HIV infection 2
Alcohol Use
Harmful alcohol use is significantly more prevalent
among Immunodeficiency Virus (HIV) patients than the
general population
National Survey on Drug Use and Health (NSDUH) reported
that there were 136.9 million alcohol users aged 12 and above
in the US in 2013; 6.3% were classified as heavy drinkers.
In contrast, according to a study done by Galvan, 13% of the
HIV- positive population who received care in the US in
1996 were either or both drug dependent or heavy
drinkers (Galvan et al., 2014)
3
Galvan et al, 2014
Type of Harmful Alcohol Use
National Institute on Alcohol Abuse and Alcoholism
(NIAAA) defines Binge Drinking as a pattern of drinking
that brings blood alcohol concentration (BAC) levels
up to 0.08 g/dL. This typically occurs 2hrs after 4 drinks
for women and 5 drinks for men
Substance Abuse and Mental Health Services
Administration (SAMHSA) defines Heavy Drinking as
drinking 5 or more on once on at least 5 days in the
past 30 days.
4 http://www.stopdrinkingadvice.org/guide/index001.php
How Harmful Alcohol Use Affects HIV
Behavioral
+ Risky sex behaviors (Theall et al., 2007)
+ Sexually transmitted disease (Townsend et al., 2010)
+ HIV reinfection & transmission (Townsend et al., 2010)
+ Missing previous HIV test (Fetch et al. 2013)
+ Utilization of emergency department (Palepu et al., 2003)
+ Medical non-adherence (Neblett et al., 2011)
Biological
+ Interact with ART (Cooper et al., 2005)
+ Mortality (Bonacini et al., 2011)
+ Depression (Slot et al., 2015)
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Current Interventions to Reduce Alcohol Use
6
Current evidence-based practice is based on self-
determination theory to develop brief intervention (BI) to reduce
alcohol use
David et al, 2005
My research interest
7
Whether interventions that improve self-
transcendence (such as meditation and guided
imaginary) would add to the effectiveness of brief
intervention on HIV-positive population
Self-Transcendence
The conceptual definition is, by Reed: “Inherent, gradual,
non-linear developmental process, resulting in increased
awareness of dimensions greater than the self and expansions of
personal boundaries within intrapersonal, interpersonal,
transpersonal and temporal domains” (McCarthy, Ling, Carini,
2013, p. 179).
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Self-Transcendence
9
Facilitate the integration of complex and conflicting elements of living, aging and dying.
A character of developmental maturity, characterized by being more pragmatic, more spiritual, more tolerant of ambiguity.
The person who uses mature forms of reasoning does not seek absolute answers to questions but seek meaning of life in the moral, social and historical context.
Expressed self-transcendence can be sharing wisdom with others, accepting death as part of life, having an interest in helping others, letting go of losses and finding spiritual meaning of life.
Nursing Theory on Self-Transcendence
Self-Transcendence
Well-Being Vulnerability
Reed (1991)
Personal and
Contextual
Factors
Why nursing is important in understanding
self-transcendence?
Many of our patients face health-threatening events with increased risk of vulnerability and mortality and therefore are potential target for promoting healing and well-being through self-transcendence
Nurses care patients in a holistic manner. We care about their overall well being, not only their physiology health but the way they approach their life and illness and the way they view their environment
We want our patients to approach end of life with maturity
12 http://www.burnett.edu/practical_nursing.html
Current stage of use of the concept in the
context of HIV
Substantial research gaps exist in literature that
examines self-transcendence in the context of HIV (Mary
et al, 1997).
Most of the existing studies are qualitative studies
looking at the individuals’ self-transcendence experience.
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Research Purpose
14
To examine how self-transcendence relates to
harmful alcohol consumption among HIV-positive
population who age 50+
Goal: to identify those HIV-positive population
who has high risk of harmful alcohol use and
deliver tailored self-transcendence related
intervention to them in addition to the traditional
brief interventions. to improve their well-being
Middle ranged theory on Self-Transcendence
Self-Transcendence
Well-Being Vulnerability
Reed (1991)
Personal and
Contextual
Factors
15
Middle ranged theory on Self-Transcendence
Self-Transcendence
Well-Being Vulnerability
Reed (1991) 17
Middle ranged theory on Self-Transcendence
Self-Transcendence
Well-Being Vulnerability
Reed (1991)
Personal and
Contextual
Factors
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Self-Transcendence
Intrapersonal
Greater awareness of one’s own philosophy
Interpersonal
Relate to others and one’s environment
Temporal
Integrate one’s past and future in a meaningful way
Transpersonal
Connect with the dimension beyond
the discernible world
Self-
Transcendence
Scale (STS)
Continuous
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Personal and Contextual Factors
Age
Demographic
Continuous
Gender
Demographic
Categorical
Cognitive ability
Mini Mental State Exam
Continuous
Significant life event
Demographic
Categorical
Personal beliefs
Survey of Personal Beliefs
Categorical
Family support
Multidimensio
nal Scale of
Perceived
Social Support
Continuous
Health status
General health
Medical record
categorical
Alcohol related health
AUDIT
Continuous
HIV-Specific health
Medical record
categorical
Reed, 1991 21
Well-being
Physical Psychosocial
Reed, 1991; Elsie, 1992
CD4
Count
Viral
Load BMI
Infectio
n
Medical
record
Continuous categorical
Life
satisfaction Positive self-
concept Self-
determination
Life
Satisfacti
on Score
Rosenberg
Self-Esteem
Scale AUDIT
C test
Continuous Continuous Continuous
22
Beck
Depressio
n
inventory
Low at risk
alcohol use
Vulnerability: Under Construction
23 Caring For The Vulnerable: Perspectives in Nursing Theory, Practice, and Research (De Chasnay, Caring for the Vulnerable)
Vulnerability is a
complex state not
easily quantifiable
Nutrition & environmental
health risk (water, food
security, air pollution)
disability, adequate
hoursing, threats to safety,
(criminal, substance abuse)
Social support, self-
esteem
Self-actualization
Study Design I: Quantitative Descriptive Study
24
Objective: To examine the association between self-
transcendence and alcohol consumption among HIV-
positive population aged 50 and above in Baltimore
Emancipatory: to emancipate the HIV-positive population
from the negative effects of alcohol
Outcome: Frequency, quantity and pattern of alcohol use
based on the outcome of AUDIT C (continuous)
Linear regression: regress self-transcendence on alcohol
use
ANCOVA: Does the association between alcohol use or
not and self-transcendence differ for different SES groups?
Study Design II: Quantitative Interventional study
25
Does nurse-led intervention on improving self-transcendence (meditation and guided imagery) improve the effectiveness of traditional brief intervention (BI) on alcohol reduction among HIV-positive population who age 50+ in Baltimore?
Post-positivism: one truth, we need to explore to get close to it.
Outcome: Frequency, quantity and pattern of alcohol use based on the outcome of AUDIT-C (continuous)
ANOVA: compare the change in alcohol use between two similar groups who had BI only and who had BI + meditation and guided imagery
Post-
screening Intervention
Pre-screening
Other theories that can be considered
26
Diathesis–Stress Model: A psychological theory that
explains behavior as a pre-dispositional vulnerability
together with stress from life experiences. This specific
model is in the context of HIV/AIDS
Trans theoretical Model
Pre-
contemplation
contemplation
Preparation
Action Maintenance
Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992
Reference
28
Moroń M. Emotion understanding, interpersonal competencies and loneliness among students[J]. Polish
Psychological Bulletin, 2014, 45(2): 223-239.
Wilsnack and Wilsnack. 39. E. R. Shore, "Drinking Patterns and Problems among Women in Paid Employment,
Alcohol Health Research World 16 (1992)
Eugene K, Susan H, Juleint N, Saira N, Bikram P. Prevalence and risk factors of major depressive disorder in
HIV/AIDS as seen in semi-urban Entebbe district, Uganda. BMC Psychiatry. 2011; 11:205
Maslow's Hierarchy of Needs by Saul McLeod twitter icon published 2007
David Markland, Richard M. Ryan, Vanessa Jayne Tobin, Stephen Rollnick (2005). Motivational Interviewing and
Self–Determination Theory. Journal of Social and Clinical Psychology: Vol. 24, No. 6, pp. 811-831.
Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption
questions (AUDIT-C): an effective brief screening test for problem drinking. Archives of internal medicine, 158(16),
1789-1795.
De Chesnay, M. (Ed.). (2005). Caring for the vulnerable: Perspectives in nursing theory, practice, and research.
Jones & Bartlett Learning.
Emmons, K. (1996). “Commentary: The Transtheoretical model of behavior change: Application to clinical practice.”
Mind/Body Medicine 1: 221-223.
Galvan FH, Burnam MA, Bing EG. Co-occurring psychiatric symptoms and drug dependence or heavy drinking
among HIVpositive people.
Substance Use and Mental Health Estimates from the 2013 National Survey on Drug Use and Health-Overview of
Findings. The NSDUH Report, September 4, 2014
Conceptual framework based on the Stress-
Diathesis Model on HIV/AIDs
Source: Prevalence and risk factors of major depressive disorder in HIV/AIDS as seen in semi-urban Entebbe district,
Uganda
Individuals Vulnerability
Socio-demographic factors
Gender(nominal)
Age(ratio)
Education(ordinal)
Employment(nominal)
Ethnicity(nominal)
Marital status(nominal)
Psychological&
social factors
Coping Psychiatry history Comorbid psychiatry
disorder Social support
Perceived social support
Social embededness
Social-ecological resources
Neurotoxic effects Adverse life events
Major depression disorder