Carolyn L Murdaugh

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• Vyavaharkar, M., Moneyham, L., Murdaugh, C., & Tavakoli, A. (2012). Factors associated with quality of life among rural women with HIV disease. AIDS and Behavior, 16(2), 295-303.
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  PMID: 21380494;Abstract: This cross-sectional study examined physical, psychological, and social factors associated with quality of life (QOL) among a sample of 399 rural women with HIV disease living in the Southeastern United States. Of the socio-demographic variables, age (p = .003), race (p
• K, D., Moneyham, L., Vyavaharkar, M., Murdaugh, C., & Phillips, K. D. (2009). Embodied work: insider perspectives on the work of HIV/AIDS peer counselors.. Health care for women international, 30(7), 572-594.
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  PMID: 19492204;PMCID: PMC2729058;Abstract: Our aim in this study was to explore HIV/AIDS peer counseling from the perspective of women actively engaged in this work within the context of a community-based program in rural areas of the southeastern United States. Based on this research we suggest that the embodied work of HIV/AIDS peer counselors is constructed around their personal identities and experiences. This work involves gaining entry to other HIV-positive women's lives, building relationships, drawing on personal experiences, facing issues of fear and stigma, tailoring peer counseling for diversity, balancing risks and benefits, and terminating relationships. Peer counselors recognize the personal and collective value of their work, which, like much of women's work within the context of family and community, lacks public visibility and acknowledgment. We discuss implications for the training and support of peer-based interventions for HIV and other women's health issues across diverse contexts and settings.
• K., D., Moneyham, L., Vyavaharkar, M., Murdaugh, C., & Phillips, K. D. (2009). Embodied work: Insider perspectives on the work of HIV/AIDS peer counselors. Health Care for Women International, 30(7), 570-592.
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  Abstract: Our aim in this study was to explore HIV/AIDS peer counseling from the perspective of women actively engaged in this work within the context of a community-based program in rural areas of the southeastern United States. Based on this research we suggest that the embodied work of HIV/AIDS peer counselors is constructed around their personal identities and experiences. This work involves gaining entry to other HIV-positive women's lives, building relationships, drawing on personal experiences, facing issues of fear and stigma, tailoring peer counseling for diversity, balancing risks and benefits, and terminating relationships. Peer counselors recognize the personal and collective value of their work, which, like much of women's work within the context of family and community, lacks public visibility and acknowledgment. We discuss implications for the training and support of peer-based interventions for HIV and other women's health issues across diverse contexts and settings.
• Jenerette, C. M., & Murdaugh, C. (2008). Testing the theory of self-care management for sickle cell disease. Research in Nursing and Health, 31(4), 355-369.
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  PMID: 18247376;Abstract: Factors predicting health outcomes in persons with sickle cell disease (SCD) were investigated within the framework of the theory of selfcare management for SCD, which proposes that vulnerability factors negatively affect health care outcomes and self-care management resources and positively mediate the relationship between vulnerability factors and health care outcomes. A cross-sectional descriptive design was used to test the model with a sample of 232 African American adults with SCD. Results supported the negative effect of vulnerability factors on health outcomes. The overall model was supported, however, self-care management resources did not mediate the relationship between vulnerability and health care outcomes. The findings provide support for interventions to increase self-care management resources to improve health care outcomes. © 2008 Wiley Periodicals, Inc.
• Boyle, J. S., Murdaugh, C., & Glittenberg, J. (2007). A tribute to Agnes Marie Aamodt, PhD, RN, FAAN, 1921-2006.. Journal of transcultural nursing : official journal of the Transcultural Nursing Society / Transcultural Nursing Society, 18(2), 93-94.
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  PMID: 17416709;
• Vyavaharkar, M., Moneyham, L., Tavakoli, A., Phillips, K. D., Murdaugh, C., Jackson, K., & Meding, G. (2007). Social support, coping, and medication adherence among HIV-positive women with depression living in rural areas of the southeastern United States. AIDS Patient Care and STDs, 21(9), 667-680.
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  PMID: 17919094;Abstract: This study examined the relationships among sociodemographic factors, social support, coping, and adherence to antiretroviral therapy (ART) among HIV-positive women with depression. The analyses reported here were limited to the 224 women receiving ART of 280 women recruited from community-based HIV/AIDS organizations serving rural areas of three states in the southeastern United States. Two indicators of medication adherence were measured; self-report of missed medications and reasons for missed medications in the past month. Descriptive statistics, correlation, and regression analyses were performed to systematically identify sociodemographic, coping, and social support variables that predicted medication adherence. In regression analysis, three variables were determined to be significant predictors accounting for approximately 30% of the variability in the self-report of reasons for missed medications. Coping focused on managing HIV disease was negatively associated, while coping focused on avoidance/denial and number of children were positively associated with reasons for missed medications. Coping by spiritual activities and focusing on the present mediated the effect of social support on self-reported missed medications. The relationship of predictor variables to self-report of missed medications was assessed using t test statistics and logistic regression analysis to determine the odds of self-reported medication adherence. Satisfaction with social support (p = 0.04), and coping focused on managing HIV disease (p = 0.002) were the best positive predictors, whereas number of children (p = 0.02) was the lone significant negative predictor of medication adherence. The study findings have implications for designing, implementing, and testing interventions based on social support and coping theories for achieving better adherence to HIV medications. © Mary Ann Liebert, Inc.
• Hendricks, C., Murdaugh, C., & Pender, N. (2006). The Adolescent Lifestyle Profile: development and psychometric characteristics.. Journal of National Black Nurses' Association : JNBNA, 17(2), 1-5.
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  PMID: 17410753;Abstract: Adolescents establish patterns of behavior and make lifestyle choices that affect their future health during their transition from childhood to adulthood. They struggle with behaviors, such as physical activity and nutrition, which will affect their risk of developing chronic diseases in adulthood. A comprehensive, easy to administer instrument is needed that is both research worthy and clinically useful in order to assess adolescent lifestyle behaviors and to plan interventions appropriately. The purpose of this paper is to report the development and testing of the Adolescent Lifestyle Profile (ALP), a Likert-type instrument to measure seven domains of a health-promoting lifestyle in adolescents. The ALP was modeled after the Health Promoting Lifestyle Profile II (HPLP II) and tested in a sample of early adolescents. Internal consistency reliability, including Cronbach's alpha, item to total correlations and subscale to total scale correlations and construct validity, including concurrent validity testing and factor analysis, indicated that the ALP is a reliable and valid scale that can be used to assess healthy lifestyle domains in adolescents.
• K., D., Moneyham, L., Murdaugh, C., & Phillips, K. D. (2006). HIV/AIDS peer counselors' perspectives on intervention delivery formats. Clinical Nursing Research, 15(3), 177-196.
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  PMID: 16801358;Abstract: This research sought to elicit HIV/AIDS peer counselors' perspectives about delivery formats for a counseling intervention. Peer counselors identified personal contact as the major advantage of the face-to-face format. Personal contact afforded counselors better opportunities to understand and assess clients' physical, emotional, and environmental status and allowed them to connect with peers in more concrete and personal ways. Being physically present was also a very direct and effective way to role model for other HIV-positive women. Peer counselors identified a number of inherent barriers and challenges to telephone interventions but also recognized potential logistic and personal advantages. Despite the overwhelming preference for the face-to-face intervention format, counselors acknowledged the potential for conducting successful peer counseling over the telephone. A significant finding was that the value and meaning of HIV/AIDS peer counselors' work transcended the limitations of either delivery format. © 2006 Sage Publications.
• Murdaugh, C., Moneyham, L., Jackson, K., Phillips, K., & Tavakoli, A. (2006). Predictors of quality of life in HIV-infected rural women: Psychometric test of the chronic illness quality of life ladder. Quality of Life Research, 15(5), 777-789.
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  PMID: 16721638;Abstract: The Chronic Illness Quality of Life Ladder (CIQOLL) underwent psychometric testing in a sample of 278 women with HIV disease. The CIQOLL, a self-anchoring striving scale based on Cantril's Ladder, measures seven domains (physical , emotional, financial, family and friends, spiritual well-being, peace of mind, and overall life satisfaction) across four time periods (present, past, future, life without a diagnosis of HIV). The domains were derived from focus groups with persons with HIV disease. Women with a diagnosis of HIV Infection, age 18 or older, residing in rural areas in the southeastern United States, completed questionnaires that measured physical functioning, HIV related symptom frequency and distress, depressive symptoms, social support, and quality of life. Procedures used to assess reliability included item-item, item-total, and subscale-subscale correlations, and Chronbach's coefficient α. Criterion-related (concurrent) validity was assessed by correlating the CIQOLL with HIV symptoms, functional status and social support. Construct validity was estimated using factor analysis and predictive modeling. Results provide preliminary evidence that the CIQOLL is a reliable and valid scale that may provide meaningful information about persons living with a chronic illness, such as HIV disease, especially low literacy and unacculturated populations. Additional research is needed to weight the domains, test the sensitivity of the scale to changes over time, and explore the usefulness of discrepancy scores. © Springer 2006.
• Boyd, M. R., Moneyham, L., Murdaugh, C., Phillips, K. D., Tavakoli, A., Jackwon, K., Jackson, N., & Vyavaharkar, M. (2005). A peer-based substance abuse intervention for HIV+ rural women: A pilot study. Archives of Psychiatric Nursing, 19(1), 10-17.
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  PMID: 15765367;Abstract: Alcohol and other drug (AOD) use plays a major role in the acquisition and spread of HIV, and the majority of women living with HIV are either active or recovering drug users. Forty-six percent of women's cases of HIV infection have been attributed to injection-drug use and 18% to women's heterosexual contacts with injection-drug users. Substance abuse often contributes to noncompliance with HIV treatment. Individuals with multiple diagnoses, such as those with HIV and substance abuse, may not be able to withstand the burden of integrating the different clinical approaches used to treat their substance abuse and other comorbid disorders such as HIV. This article reports the results of an intervention pilot study testing a peer counseling intervention for substance abuse in rural women with HIV. Thirteen women completed the intervention. Although limited by sample size, results suggest that this intervention was effective in helping women to acknowledge problems with their alcohol and drug abuse and to begin taking steps to achieve sobriety. © 2005 Elsevier Inc. All rights reserved.
• Hendricks, C. S., Cesario, S. K., Murdaugh, C., Gibbons, M. E., Servonsky, E. J., Bobadilla, R. V., Hendricks, D. L., Spencer-Morgan, B., & Tavakoli, A. (2005). The influence of father absence on the self-esteem and self-reported sexual activity of rural southern adolescents.. The ABNF journal : official journal of the Association of Black Nursing Faculty in Higher Education, Inc., 16(6), 124-131.
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  PMID: 16382796;Abstract: The absence of the father in the resident home is an increasing trend in the United States, and the belief that the absence of fathers is lined with a variety of social pathologies is gaining national momentum. This study explored the relationship of father absence on self-esteem and self-reported sexual activity among rural southern adolescents. A sample of 1,409 adolescents (558 males and 851 females) aged 11 to 18 years was surveyed, and the Miller Self-Esteem Questionnaire (MSQ) was used to measure self-esteem. Analysis revealed that increased sexual activity occurred by adolescents in homes where no father present in the residence. Although a statistical significance was noted in the relationship between father absence and lower self-esteem, the magnitude of the difference was not large. Further, no relationship between self-esteem and sexual activity was noted. Seemingly, the absence of the father has a potentially detrimental effect on adolescents' lifestyle choices. Consideration of the notion that the phenomena of fathering rather than the mere presence of a father may contribute to differences in adolescent's lifestyle choices should be studied.
• Jenerette, C., Funk, M., & Murdaugh, C. (2005). Sickle cell disease: A stigmatizing condition that may lead to depression. Issues in Mental Health Nursing, 26(10), 1081-1101.
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  PMID: 16284000;Abstract: Individuals with a chronic illness such as sickle cell disease are at risk for depression. Moreover, they are at risk for untreated depression. Depression may go untreated because of the stigma and high rates of disability associated with this chronic illness that most often affects African Americans in the United States. The purpose of this cross-sectional study was to describe depressive symptoms using the Beck Depression Inventory Fast Screen in a sample of 232 African American adults with sickle cell disease. Respondents reported higher levels of depression (26%) and depressive symptoms (32%) than did the overall United States population (9.5%). All adults with chronic illnesses need to be screened for depression in primary care practice sites where the diagnosis and treatment of depression needs to be coordinated. Copyright © Taylor & Francis Inc.
• Moneyham, L., Murdaugh, C., Phillips, K., Jackson, K., Tavakoli, A., Boyd, M., Jackson, N., & Vyavaharkar, M. (2005). Patterns of risk of depressive symptoms among HIV-positive women in the Southeastern United States. Journal of the Association of Nurses in AIDS Care, 16(4), 25-38.
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  PMID: 16435528;Abstract: Depressive symptoms are a common response to HIV disease, and women appear to be at particularly high risk. The authors report results from a cross-sectional analysis of data collected from 280 rural women with HIV/AIDS in the Southeastern United States aimed at identifying risk factors of depressive symptoms. Stress theory provided a framework for identification of potential risk factors. Descriptive statistics, measures of association, and regression analyses were used to systematically identify patterns of risk. The final regression model included 22 factors that accounted for 69% of the variance in depressive symptoms. The majority of variance in depressive symptoms was accounted for by only six variables: the frequency of HIV symptoms, recent experiences of sadness/hopelessness, the availability of social support, and the use of three coping strategies: living positively with HIV, isolation/withdrawal, and denial/avoidance. The results suggest a number of intervention strategies for use with rural women with HIV/AIDS. Copyright © 2005 Association of Nurses in AIDS Care.
• Phillips, K. D., Moneyham, L., Murdaugh, C., Boyd, M. R., Tavakoli, A., Jackson, K., & Vyavaharkar, M. (2005). Sleep disturbance and depression as barriers to adherence. Clinical Nursing Research, 14(3), 273-293.
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  PMID: 15995155;Abstract: This study examined the relationships among subjective sleep disturbance, depressive symptoms, and adherence to medications among HIV-infected women. HPV-infected women (N = 173) were recruited through community AIDS service organizations throughout South Carolina. Participants completed the Pittsburgh Sleep Quality Index (PSQI), the Centers for Epidemiological Studies Depression Scale (CES-D), and a modified version of the Adults AIDS Clinical Trials Group Adherence Baseline Questionnaire. Women who reported greater sleep disturbance also reported a higher level of depressive symptoms and reported poor adherence to their medication regimen. Depression helped to explain the relationship between sleep quality and adherence. Results indicate that assessment and management of sleep disturbance and depressive symptoms in women with HIV disease is important to promote medication adherence. © 2005 Sage Publications.
• Murdaugh, C., Hunt, S., Sowell, R., & Santana, I. (2004). Domestic violence in Hispanics in the Southeastern United States: A survey and needs analysis. Journal of Family Violence, 19(2), 107-115.
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  Abstract: Violence is a significant health issue for Latinas in the United States (US), with 54.9% reporting violent victimization. However, little is known about battering among Hispanic women in the southeast. The southeastern corridor, a rural area in search of cheap labor, is a magnet for undocumented agricultural workers. The purpose of this study was to describe domestic violence in Hispanic/Latino women in the southeastern US, including type and frequency of violence experienced, barriers to obtaining treatment, and services needed by women who have been abused. Hispanic women completed questionnaires developed from information from focus groups. Results indicate that domestic violence is a major health problem for women in the southeast, and document previous findings as well as offer new insights about Hispanic women who have experienced domestic violence. Implications are discussed in terms of the need for community partnerships and interventions, as well as routine screening and crisis intervention.
• Sowell, R. L., Murdaugh, C. L., Addy, C. L., Moneyham, L., & Tavokoli, A. (2002). Factors influencing intent to get pregnant in HIV-infected women living in the southern USA. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 14(2), 181-191.
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  PMID: 11940277;Abstract: This descriptive study sought to identify factors that influence HIV-infected women's intent to get pregnant. Interviews were conducted with a convenience sample of n = 322 HIV-infected women at risk for pregnancy. Participants were predominantly African-American (84.4%), single (57.9%), and ranged in age from 17 to 48 years. Forty per cent (n = 128) of the women had been pregnant since becoming HIV-positive. Potential factors influencing intent to get pregnant that were examined included demographic characteristics, HIV-related factors and personal beliefs and attitudes. In simple logistic regression models, younger age, increased motivation for child bearing, decreased perceived threat of HIV, decreased HIV symptomatology, higher traditional gender role orientation, and greater avoidance coping were all associated with greater intent to get pregnant. Following a model selection procedure, motivation for child bearing (OR = 16.05, 95% CI 7.95, 30.41) and traditional sex roles (OR = 4.49, 95% CI 1.44, 13.55) were significantly associated with greater intent to get pregnant. Traditional gender role orientation and motivation for childbearing are significant factors in predicting intent to get pregnant among HIV-infected women. These factors, as well as other non HIV-related factors, need to be routinely assessed by health care providers in developing plans of care for HIV-infected women.
• Sowell, R. L., Phillips, K. D., Seals, B., Murdaugh, C., & Rush, C. (2002). Incidence and correlates of physical violence among HIV-infected women at risk for pregnancy in the southeastern United States.. The Journal of the Association of Nurses in AIDS Care : JANAC, 13(2), 46-58.
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  PMID: 11936064;Abstract: To identify the incidence and correlates of physical and sexual violence among HIV-infected women at risk for pregnancy, a cross-sectional examination was conducted within a longitudinal study of reproductive decision making. Participants consisted of 275 HIV-infected women 17 to 49 years of age (mean = 30.1 years). Women were predominantly African American (87%) and single (82%), with annual incomes of $10,000 or less (66%). Overall, 68% of the women reported experiencing lifetime physical and/or sexual violence. Before becoming HIV infected, 65% of the women reported having been physically or sexually abused. After HIV diagnosis, 33% of the women reported experiencing physical or sexual abuse. Women reporting greater violence were more likely to disclose their HIV-seropositive status to their sex partner. Using logistic regression, greater intent to get pregnant (odds ratio [OR] = 0.933), decreased present life satisfaction (OR = 1.048), having three or more children (OR = 0.474), and history of drug use (OR = 0.794) significantly distinguished between women who reported physical and/or sexual violence and those who did not.
• Latham, B. C., Sowell, R. L., Phillips, K. D., & Murdaugh, C. (2001). Family functioning and motivation for childbearing among HIV-infected women at increased risk for pregnancy. Journal of Family Nursing, 7(4), 345-370.
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  Abstract: This study examined family composition and functioning in a cohort of HIV-infected women of reproductive age living in the southern United States. Participants were predominantly single (82.2%), African American women (86.7%) with annual incomes of less than $10,000 (65.5%), with a mean age of 31.2 years. Using the Family Apgar Scale as a measure of perceived family functioning, women reported that their families functioned moderately well. Multiple regression analysis showed that level of education, life satisfaction, and coping through avoidance and coping by seeking social support were positively associated with family functioning. In contrast, a history of interpersonal verbal violence and a history of drug use were negatively associated with family functioning. These six factors accounted for 26% of the variance. Study findings support the need for comprehensive nursing interventions that include addressing family issues if HIV-infected women are to be provided quality care. © 2001 Sage Publications.
• Sowell, R. L., Murdaugh, C. L., Addy, C., Moneyham, L., Tavokoli, A., & Misener, T. (2001). Preventing perinatal human immunodeficiency virus transmission: Factors influencing women's intentions toward zidovudine therapy. Southern Medical Journal, 94(12), 1177-1184.
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  PMID: 11811856;Abstract: Background. Despite the benefits of zidovudine (ZDV) therapy in preventing perinatal transmission of the human immunodeficiency virus, HIV-infected women may not accept or adhere to therapy. Methods. This descriptive study identified factors in 322 HIV-infected women that influence intention to take ZDV if becoming pregnant and to give it to their newborns. Results. Logistic regression analysis showed the likelihood of taking ZDV in pregnancy and giving it to newborns was greater in women who believed ZDV slowed disease progression, ZDV was effective in preventing perinatal transmission, and their primary health care provider (PHCP) was positive about ZDV therapy. Additionally, women who were sexually active and had been pregnant since HIV diagnosis were more likely to intend to give ZDV to newborns. Conclusions. Positive beliefs concerning ZDV effectiveness and the perception that their PHCP has a positive view of ZDV therapy during pregnancy are significant factors in women's ZDV-related decisions.
• Fleury, J., Keller, C., & Murdaugh, C. (2000). Social and contextual etiology of coronary heart disease in women. Journal of Women's Health and Gender-Based Medicine, 9(9), 967-978.
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  PMID: 11103096;Abstract: We explored the social and contextual etiology of coronary heart disease (CHD) prevention and management in women. Social and contextual influences on CHD risk include such factors as socioeconomic status, access to healthcare, cultural mores, working conditions including work overload, multiple role responsibilities, and social isolation. Women, particularly economically disadvantaged women, occupy lower levels on the social status hierarchy and, therefore, experience more stressful life experiences, less favorable living conditions, and less opportunity to affect positive health behavior and outcomes. Women are often discriminated against economically, politically, and socially, and this discrimination may adversely affect their efforts at CHD health promotion and treatment. Multiple role responsibilities within the family and psychosocial factors, including chronic life stress, are critical to an understanding of the health status of women, particularly poor and minority women. Although community-based interventions appear to be ideal for addressing the contextual risks related to CHD in women, a number of issues need to be considered, for example, the limited acknowledgment of secular trends in economic development that influence lifestyle decisions and health promotion efforts. Directions for research and interventions include recognition of the full spectrum of CHD risk in women, recognition of culturally competent interventions, and recognition of the need for empowerment of women.
• Hendricks, C. S., Murdaugh, C., Tavakoli, A., & Hendricks, D. L. (2000). Health promoting behaviors among rural southern early adolescents.. The ABNF journal : official journal of the Association of Black Nursing Faculty in Higher Education, Inc, 11(5), 123-128.
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  PMID: 11760252;Abstract: A central element in attaining the goals and objectives of Healthy People 2010 is promoting healthy behavior lifestyles. Health promotion continues to be sanctioned as the long term most cost effective approach to a reduction in preventable health problems. Adolescents are presently an age group in jeopardy of making the transition into adulthood with healthy lifestyles. This paper describes the use of the Health Promoting Lifestyle Profile (HPLP) (Walker, Sechrist, and Pender, 1987) as a measure of health promoting behaviors in a group of rural southern early adolescents (1036 seventh and eight graders; 81% were African American). The findings suggest that rural southern adolescents perceive themselves to be enganging in health promoting lifestyle behaviors. However, some HPLP subscales seemed to be especially difficult for adolescents.
• Murdaugh, C., Russell, R. B., & Sowell, R. (2000). Using focus groups to develop a culturally sensitive videotape intervention for HIV-positive women. Journal of Advanced Nursing, 32(6), 1507-1513.
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  PMID: 11136420;Abstract: Research-based interventions for women with the human immunodeficiency virus (HIV) are usually developed without input from the women who receive the intervention. An exploratory study was performed using focus group methodology to develop a culturally sensitive videotape intervention for educating HIV-positive women about pregnancy and antiretroviral use. Women who met the study criteria were HIV-positive and of childbearing age. These women volunteered to participate in the focus groups to provide information on decisions concerning pregnancy and antiretroviral use during pregnancy to decrease perinatal transmission. A total of five focus groups were conducted in 1998. Responses to three questions that were relevant to the video are presented in this article. Information gained from the focus groups was used successfully to develop a videotape currently being used in a multisite intervention study. Focus group methodology is a useful strategy to develop culturally and content relevant educational interventions for research and practice.
• Kroposki, M., Murdaugh, C. L., Tavakoli, A. S., & Parsons, M. (1999). Role clarity, organizational commitment, and job satisfaction during hospital reengineering.. NursingConnections, 12(1), 27-34.
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  PMID: 10401399;Abstract: This study investigated the relationships among role conflict, role ambiguity, organizational commitment, and job satisfaction experienced by clinical team members in a hospital undergoing reengineering. The sample consisted of 409 registered nurses (RNs) and 278 non-RNs. Participants who experienced much role conflict and ambiguity exhibited less organizational commitment and job satisfaction. RNs had more role conflict and ambiguity than non-RNs. No significant differences in role conflict and role ambiguity, organizational commitment, and job satisfaction were observed between RNs working on medical-surgical units and those on specialty units. Strategies that reduce role conflict and role ambiguity to increase organizational commitment and job satisfaction are discussed.
• Dennerstein, L., Feldman, S., Murdaugh, C., Rossouw, J., & Tennstedt, S. (1998). Gender and health issues in ageing. Australasian Journal on Ageing, 17(SUPPL. 1), 19-21.
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  Abstract: There are pronounced gender differences relating to health and ageing reflecting biological and social differences and transitions and adaption to these. The most obvious biological difference is that women have a finite length of reproductive functioning, the termination of which is marked by menopause. The menopausal transition has physical, psychological and sexual concomitants. Postmenopausal life is characterise by increased cardiovascular and osteoporotic risk. Interventions for these disorders have not been adequately evaluated. Men live on average about 7 years less than women in most developed countries. Women form the majority of carers. The most common cost of caring is social, a restriction in personal and leisure time, and is directly related to the amount of care provided. The negative health effects of caring are primarily psychological, not physical. Most of the widowed are women. An Australian study found that women widowed in the last 12 months had lower self- related health and were more likely to report they were stressed about their health. Recently widowed women scored lower on all the subscales of the SF-36 and were also more likely to be taking medication for 'nerves' and 'medication to help you sleep'. Women widowed longer than 12 months did not score significantly differently than married women on these parameters. Widowed women reported more difficulty managing on their income than did married women, regardless of the length of widowhood. Widows also reported more stress with children and other family members than did married women.
• Murdaugh, C. (1998). health-related quality of life in HIV dis ease: Achieving a balance. Journal of the Association of Nurses in AIDS Care, 9(6), 59-71.
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  PMID: 9805297;Abstract: Using grounded theory methods, open-ended interviews were conducted with persons diagnosed with HIV disease to explore and describe how they adjust to living with their disease in relation to their healthrelated quality of life over the illness trajectory. A substantive theory was generated tliat describes the process of learning to live with the unpredictability of the disease to maintain life quality. "Achieving a Balance," the core process identified, describes the psychosocial adjustment process of persons with HIV disease from the time of diagnosis to their current circumstances. The process involves balancing the requirements of living with the progression of the disease with the desire to maintain control over one's life, to the extent possible, to maintain life quality. Achieving a Balance is described within the illness trajectory with four major stages - Disintegrating, Renormalizing, Coming to Terms, and Creating Meaning. Characteristics within these stages, which enhance or diminish life quality are described, and a definition of health-related quality, of life is proposed. Interventions are recommended for nurses who care for persons living with HIV disease. Copyright © 1998 Association of Nurses in AIDS Care.
• Murdaugh, C. L. (1998). The value of mentors and facilitators in the pursuit of excellence.. The Journal of cardiovascular nursing, 12(2), 65-72.
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  PMID: 9429116;Abstract: Family members, teachers, and colleagues are all influential in our socialization as professionals and nurse scientists. This article discusses lessons learned from mentors and facilitators during the various stages in my career, including clinical practice, graduate education, and academia. The value of postdoctoral experiences, whether formal or informal, in the pursuit of excellence is also discussed. Finally, the need to maintain a balanced quality of life is stressed in all phases of a career trajectory to facilitate attainment of our goals and the ability to maintain a standard of excellence.
• Murdaugh, C. (1997). Health-related quality of life as an outcome in organizational research. Medical Care, 35(11 SUPPL. 1), NS41-NS48.
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  PMID: 9366878;Abstract: This article discusses the conceptual and methodological issues that continue to plague health-related quality of life (HRQOL) research. The current conceptualizations of the construct are reviewed to make explicit the issues of diversity and lack of consensus in definitions, validity of the conceptual unity of multiple domains, and lack of attention to the integration of the HRQOL construct into a theoretical meaningful model. Inadequately addressed conceptual issues have resulted in the proliferation of scales to measure HRQOL the measurement issues to a need to focus on precision and sensitivity of measures. The author offers a new conceptualization of HRQOL, which encompasses both health-care provider and patient perspectives. © 1997 Lippincott-Raven Publishers.
• Murdaugh, C. L., & Vanderboom, C. (1997). Individual and community models for promoting wellness.. The Journal of cardiovascular nursing, 11(3), 1-14.
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  PMID: 9095450;Abstract: The health care field is the largest industry in the United States and comprises 14% of the gross national product. Payers of those health care costs are now demanding that more attention be placed on prevention of disease and promotion of wellness. Traditional individual models of wellness promotion and new community models of wellness promotion are reviewed. The strengths and weaknesses of the models are discussed to provide nurses with the information needed to make decisions about which model or combination of models will be most successful in their wellness promotion efforts.
• Ross, G. W., Abbott, R. D., Petrovitch, H., Masaki, K. H., Murdaugh, C., Trockman, C., Curb, J. D., & White, L. R. (1997). Frequency and characteristics of silent dementia among elderly Japanese- American men: The Honolulu-Asia Aging Study. Journal of the American Medical Association, 277(10), 800-805.
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  PMID: 9052709;Abstract: Objective.-To determine the frequency of unrecognized dementia in a group of men found to have dementia by population survey, and to identify factors associated i with the failure of a family informant to recognize significant memory impairment. Design and Setting.-The Honolulu-Asia Aging Study, a population-based study of dementia among elderly Japanese-American men living on the island of Oahu, Hawaii. Data for this study were from the dementia prevalence survey, 1991-1993. Study Participants.-A total of 191 noninstitutionalized men with dementia who had a reliable family informant. Main Outcome Measures.-Failure of family informants to recognize a problem with thinking or memory in subjects with dementia. Results.-A total of 21% of family informants failed to recognize a problem with memory among subjects subsequently found to have dementia. Among subjects with very mild dementia, 52% of family informants failed to recognize a significant memory problem compared with 13% among more severely demented subjects. Of the subjects with dementia whose family informants did recognize a memory problem, 53% failed to receive a medical evaluation for this problem. For all family informants, increasing age, fewer years of education, less severe dementia, fewer behavioral complications, fewer functional disabilities, and better performance on certain tests of memory and language were significantly associated with the family informant's failure to recognize a problem with memory. When the family informants were wives living with husbands, less severe dementia, fewer behavioral complications, fewer functional disabilities, and intact remote memory were associated with unrecognized dementia. Conclusions.-Unrecognized dementia was common in our population, especially among mild cases. Cognitive screening programs for the elderly and public education policies designed to increase awareness of early signs of dementia are needed if interventions for individuals with potentially treatable dementias are to be implemented.
• Trockman, C. T., Murdaugh, C., Kadohiro, J. K., Petrovitch, H., Curb, J. D., & White, L. O. (1997). Adapting instruments for caregiver research in elderly Japanese American women. Journal of Cross-Cultural Gerontology, 12(2), 109-120.
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  PMID: 14617931;Abstract: Accounting for cultural differences in caregiver research is now widely recognized. However, adapting instruments to assure reliable and valid data across cultures has been neglected, leading to concerns about information obtained in cross cultural research. This paper discusses instrumentation issues which influence the assessment of information in elderly women of Japanese descent who are caregivers to persons with dementia. Data from interviews in the Honolulu Aging and Caregiver Study focus on semantic, content, technical, criterion and conceptual equivalence. © 1997 Kluwer Academic Publishers.
• White, L., Petrovitch, H., Ross, G. W., Masaki, K. H., Abbott, R. D., Teng, E. L., Rodriguez, B. L., Blanchette, P. L., Havlik, R. J., Wergowske, G., Chiu, D., Foley, D. J., Murdaugh, C., & Curb, J. D. (1996). Prevalence of dementia in older Japanese-American men in Hawaii: The Honolulu-Asia aging study. Journal of the American Medical Association, 276(12), 955-960.
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  PMID: 8805729;Abstract: Objective. - To determine prevalence of dementia and its subtypes in Japanese-American men and compare these findings with rates reported for populations in Japan and elsewhere. Design and Setting. - The Honolulu Heart Program is a prospective population-based study of cardiovascular disease established in 1965. Prevalence estimates were computed from cases identified at the 1991 to 1993 examination. Cognitive performance was assessed using standardized methods, instruments, and diagnostic criteria. Participants. - Subjects were 3734 Japanese-American men (80% of surviving cohort) aged 71 through 93 years, living in the community or in institutions. Main Outcome Measures. - Age-specific, age-standardized, and cohort prevalence estimates were computed for dementia (all cause) defined by 2 sets of diagnostic criteria and 4 levels of severity. Prevalence levels for Alzheimer disease and vascular dementia were also estimated. Results. - Dementia prevalence by Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised ranged from 2.1% in men aged 71 through 74 years to 33.4% in men aged 85 through 93 years. Age-standardized prevalence was 7.6%. Prevalence estimates for the cohort were 9.3% for dementia (all cause), 5.4% for Alzheimer disease (primary or contributing), and 4.2% for vascular dementia (primary or contributing). More than 1 possible cause was found in 26% of cases. The Alzheimer disease/vascular dementia ratio was 1.5 for cases attributed primarily to Alzheimer disease or vascular dementia. Conclusions. - Prevalence of Alzheimer disease in older Japanese-American men in Hawaii appears to be higher than in Japan but similar to European-ancestry populations. Prevalence of vascular dementia appears to be only slightly lower than in Japan, but higher than in European-ancestry populations. Further cress-national research with emphasis on standardized diagnostic methods is needed.
• Milton, D., Verran, J., Murdaugh, C., & Gerber, R. (1992). Differentiated group professional practice in nursing: a demonstration model.. Nursing Clinics of North America, 27(1), 23-30.
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  PMID: 1545989;Abstract: This innovative professional practice model was developed to assist in the redesign of the current nursing care delivery system in hospitals. It is expected that this model will facilitate the promotion of professional practice and that the results will be positive ones for patients, nurses, and hospitals. As Barry and Gibbons wrote recently, "Changing circumstances have become so compelling that it is no longer a question of whether familiar systems need redesigning, but rather how soon and by what means a different system will take place of the existing one."
• Murdaugh, C. (1990). Coronary artery disease in women.. The Journal of cardiovascular nursing, 4(4), 35-50.
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  PMID: 2376765;Abstract: Cardiovascular disease is the number one cause of death in American women over age 40. Following menopause, the risk for coronary artery disease (CAD) in women is the same as for men. In addition, the major factors that place men at risk are the same for women. However, differences exist in the presentation of symptoms, the ease of diagnosis of CAD, and the morbidity and mortality rates following myocardial infarction (MI), coronary artery bypass surgery, and angioplasty. Because of role differences in men and women, more attention must be paid to developing successful health-promoting and life-style-change strategies in women of all ages.
• Murdaugh, C. (1990). Recruitment issues in research with special populations.. The Journal of cardiovascular nursing, 4(4), 51-55.
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  PMID: 2376766;Abstract: Special populations have been underrepresented in cardiovascular research for many reasons. However, strategies are available to obtain greater numbers of underrepresented populations in research. These strategies may be complex, time consuming, and costly, but they are necessary to ensure that eligible minorities participate in research to identify the major cardiovascular risk factors and appropriate interventions.
• Winters Jr., W. L., McIntosh, H. D., Cheitlin, M. D., Elon, R., Graboys, T. B., B., S., Murdaugh, C., Orentlicher, D., Ports, T. A., Rainer, W., Rapaport, E., Rial, W. Y., Saunders, E., Ullyot, D. J., & Weg, J. G. (1990). Task force II: The relation of cardiovascular specialists to patients, other physicians and physician-owned organizations. Journal of the American College of Cardiology, 16(1), 11-16.
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  PMID: 2358584;Abstract: 1. 1. The American College of Cardiology acknowledges the continuum of changing societal, medical and economic perspectives affecting traditional medical ethics. Primacy of patient responsibility remains paramount to the cardiovascular specialist who at the same time should participate in the development of broader societal programs. 2. 2. Medical decisions should be freely and jointly formulated by the patient and the cardiovascular specialist with appropriate sensitivity to such matters as mental competence, pertinent medical information and standards of care, sufficient time for contemplation, informed consent, patient right of refusal, physician right to refuse to provide inappropriate care and the right of patient, physician or third party payer to seek consultation or additional opinions. 3. 3. The cardiovascular specialist should make a special effort to clarify and document patient preferences regarding end-of-life treatment through some form of advance directive. 4. 4. The cardiovascular specialist bears a moral obligation to provide medical care to any patient who is HIV positive or has AIDS. 5. 5. A conflict of interest occurs when a cardiovascular specialist places personal or financial interest ahead of the welfare and health of a patient. Professional accountability should be established through local or regional peer review. 6. 6. The American College of Cardiology encourages and supports a renewed dedication to the principles of medical ethics, particularly in the field of cardiovascular disease. Cardiovascular specialists are encouraged to participate in the promulgation of medical ethics by teaching and by example, individually and with others. © 1990.
• Murdaugh, C. L. (1989). Nursing research. The use of grounded theory methodology to study the process of life-style changes.. The Journal of cardiovascular nursing, 3(2), 56-58.
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  PMID: 2913196;Abstract: This article describes a method of evaluating research with the use of grounded theory methology, a qualitative research technique. The preceding article by Frenn and colleagues, which uses this method to study the process of life-style change, is evaluated as an example. Sample procedures, data collection and analysis, and evaluation of scientific merit are discussed.
• Henker, R. A., Smith, R. G., & Murdaugh, C. (1988). Effects of nursing interventions on cardiac output in the patient with a total artificial heart.. The Journal of cardiovascular nursing, 2(2), 56-67.
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  PMID: 3351554;
• Henker, R., & Murdaugh, C. (1988). Effects of pneumatic artificial heart driver on the rate of isovolumic pressure rise. Artificial Organs, 12(6), 519-525.
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  PMID: 3214332;Abstract: The aim of the research was to investigate the effects of three parameters of the artificial heart's performance on the (+) dP/dt max. Specifically, the effects of heart rate, left-sided drive pressure, and percent systole (the independent variables) on the (+) dP/dt max (the dependent variable) were examined. The study was conducted using a mock circulation which was connected to an artificial heart. Data were collected using the COMDU software developed for the computer which monitors the artificial heart. Stepwise regression analysis was used to test the three hypotheses. Hypothesis one stated the heart rate would significantly effect the (+) dP/dt max. The hypothesis was not supported. Hypothesis two stated the percent systole would significantly effect the (+) dP/dt max. Hypothesis two was also not supported. Hypothesis three stated the drive pressure would significantly effect the (+) dP/dt max. The hypothesis was supported as drive pressure accounted for 4% of the variance in (+) dP/dt max; however, the results were not clinically significant. Limitations in the study were multicollinearity among the independent variables, small sample size, and the inability of the mock circulation to represent human responses.
• Murdaugh, C. (1988). From paper to practice: a commentary on Hill et al.. The Journal of cardiovascular nursing, 2(3), 79-81.
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  PMID: 3379463;
• Murdaugh, C. (1988). Identifying a researchable problem.. The Journal of cardiovascular nursing, 2(2), 84-86.
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  PMID: 3351557;
• Murdaugh, C. (1988). Writing a research abstract.. Progress in cardiovascular nursing, 3(3), 98-100.
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  PMID: 3420104;
• Murdaugh, C. L., & O'Rourke, R. A. (1988). Coronary heart disease in women: Special considerations. Current Problems in Cardiology, 13(2), 78-156.
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  PMID: 3282807;
• Sennott-Miller, L., Murdaugh, C., & Hinshaw, A. S. (1988). Magnitude estimation: issues and practical applications.. Western journal of nursing research, 10(4), 414-424.
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  PMID: 3188501;
• Verran, J., Murdaugh, C., Gerber, R., & Milton, D. (1988). Shortage solutions: refining the science of managing nursing resources.. Aspen"s advisor for nurse executives, 4(3), 4-5.
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  PMID: 3273904;
• Mishel, M. H., & Murdaugh, C. L. (1987). Family adjustment to heart transplantation: redesigning the dream. Nursing Research, 36(6), 332-338.
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  PMID: 3313290;Abstract: The processes family members of heart transplant recipients use to manage the unpredictability evoked by the need for and receipt of heart transplantation were explored. Twenty family members were theoretically sampled using the grounded theory approach. Three separate family support groups, each of 12 weeks duration, provided data for constant comparative analysis. Redesigning the dream was identified as the integrative theme in the substantive theory that described how family members gradually modify their beliefs about organ transplantation and develop attitudes and beliefs to meet the challenge of living with continual unpredictability. The theory consists of three concepts - immersion, passage, and negotiation - which parallel the stages of waiting for a donor, hospitalization, and recovery.
• Murdaugh, C. (1987). Nursing research.. The Journal of cardiovascular nursing, 1(2), 82-85.
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  PMID: 3646298;
• Murdaugh, C. L., & Verran, J. A. (1987). Theoretical modeling to predict physiological indicants of cardiac preventive behaviors. Nursing Research, 36(5), 284-291.
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  PMID: 3650802;Abstract: The Preventive Behavior Model was tested and expanded to explore the influence of perceived barriers, benefits, health value orientations, and certain health care activities on physiological outcomes. Data from 41 subjects from a health screening program were analyzed. Four empirical models resulted, explaining 39%, 45%, 66%, and 47% of the variance in cholesterol, high density lipoprotein, systolic blood pressure, and diastolic blood pressure, respectively. Significant variables in the four models provide important clues for understanding factors that influence physiological outcomes of risk factors reduction.
• Clochesy, J. M., Whittaker, A. A., & Murdaugh, C. L. (1986). Hypoplastic left heart syndrome: A review and the report of two cases. Heart and Lung: Journal of Acute and Critical Care, 15(1), 23-28.
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  PMID: 2417988;Abstract: Caring for infants with HLHS and their parents is challenging. Social policies of the 1980s such as 'Baby Doe', 'Baby Fae', and diagnosis-related groups raise additional ethical and economic or financial questions. The nurse must diligently monitor tissue perfusion in the infant and the parents' coping with loss, while struggling with difficult ethical/legal issues.
• Murdaugh, C. (1986). Nursing research.. The Journal of cardiovascular nursing, 1(1), 87-89.
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  PMID: 3639922;
• Murdaugh, C., & Hinshaw, A. S. (1986). Theoretical model testing to identify personality variables effecting preventive behaviors. Nursing Research, 35(1), 19-23.
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  PMID: 3632841;Abstract: To test the preventive behavior model, the impact of perceived barriers and benefits and health value orientations on two health care activities (smoking and exercise) was examined. Data from 76 subjects who had taken part in a health screening program were analyzed using regression analysis. A reduced empirical model for exercise resulted, explaining 46% of the variance. However, only one variable that accounted for 7% of the variance was significant in explaining smoking behavior. Significant personality variables in the exercise model provide clues toward understanding psychological factors that may be operating to influence an individual's participation in health care activities.
• Carrieri, V. K., Murdaugh, C., & Janson-Bjerklie, S. (1984). A framework for assessing pulmonary disease categories.. Focus on critical care / American Association of Critical-Care Nurses, 11(2), 10-16.
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  PMID: 6562044;
• Carrieri, V., Stotts, N., Murdaugh, C., Levinson, J., & Holzemer, W. L. (1982). The use of cardiopulmonary assessment skills in the clinical setting.. Western journal of nursing research, 4(1), 5-20.
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  PMID: 6917638;
• Murdaugh, C. (1982). Using research in practice. Can (cardiac) patients be taught effectively in the critical care setting?. Focus On Aacn, 9(3), 11-14.
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  PMID: 6920318;
• Murdaugh, C. L. (1982). Barriers to patient education in the coronary care unit.. Cardio-vascular nursing, 18(6), 31-36.
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  PMID: 6923778;
• Murdaugh, C. (1981). Problems in doing nursing research: measurement error and attenuation.. Western journal of nursing research, 3(2), 252-256.
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  PMID: 6913323;
• Murdaugh, C., Kramer, M., & Schmalenberg, C. E. (1981). The teaching of nursing research: a survey report.. Nurse educator, 6(1), 28-35.
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  PMID: 6904864;
• Murdaugh, C. L. (1980). Effects of nurses' knowledge of teaching-learning principles on knowledge of coronary care unit patients.. Heart and Lung: Journal of Acute and Critical Care, 9(6), 1073-1078.
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  PMID: 6905843;