Joan L Shaver

Interests

Research

midlife to older women's health and sleep science (insomnia)

Teaching

leadership, active learning, women's health, chronically fatiguing conditions, sleep health, stress activation and relationship to illness/wellness

Courses

Scholarly Contributions

Journals/Publications

• Shaver, J. L., & Iacovides, S. (2018). Sleep in Women with Chronic Pain and Autoimmune Conditions A Narrative Review. Sleep Medicine Clinics, 13(3), 375-394. doi:10.1016/j.jsmc.2018.04.008
• Shaver, J. L., & Woods, N. F. (2015). Sleep and menopause: a narrative review. Menopause (New York, N.Y.), 22(8), 899-915.
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  Our overall aim-through a narrative review-is to critically profile key extant evidence of menopause-related sleep, mostly from studies published in the last decade.
• Berg, J. A., Shaver, J., Olshansky, E., Woods, N. F., & Taylor, D. (2013). A call to action: Expanded research agenda for women's health. Nursing Outlook, 61(4), 252-.
• Shaver, J. L. (2013). Hot flashes and sleep: Pieces of the puzzle. Menopause, 20(9), 877-880.
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  PMID: 23942246;
• Shaver, J., Olshansky, E., & Woods, N. F. (2013). Women's health research agenda for the next decade. A report by the Women's Health Expert Panel of the American Academy of Nursing. Nursing Outlook, 61(1), 16-24.
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  PMID: 22819627;Abstract: Research in women's health has regained momentum with the recent release of several reports from various institutes and organizations. The Office of Research on Women's Health (ORWH) of the National Institutes of Health and the Institute of Medicine (IOM) both reported on women's health research. Within a year, Congress enacted the Affordable Care Act, stipulating support for clinical preventive services for women, prompting further reports focused on clinical care for women. These two research-dominant reports (NIH ORWH and the IOM) are the subject of this manuscript. The purpose is to outline and critically analyze the reports from a grounded nursing perspective and to propose a complementary and expanded agenda for furthering research in women's health. A separate manuscript analyzes and makes recommendations based on additional reports about clinical services and policies that will benefit the health status of women. © 2013 Elsevier Inc.
• Abu-Asab, M., Koithan, M., Shaver, J., & Amri, H. (2012). Analyzing heterogeneous complexity in complementary and alternative medicine research: A systems biology solution via parsimony phylogenetics. Forschende Komplementarmedizin, 19(SUPPL. 1), 42-48.
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  PMID: 22327551;PMCID: PMC3292783;Abstract: Systems biology offers cutting-edge tools for the study of complementary and alternative medicine (CAM). The advent of 'omics' techniques and the resulting avalanche of scientific data have introduced an unprecedented level of complexity and heterogeneous data to biomedical research, leading to the development of novel research approaches. Statistical averaging has its limitations and is unsuitable for the analysis of heterogeneity, as it masks diversity by homogenizing otherwise heterogeneous populations. Unfortunately, most researchers are unaware of alternative methods of analysis capable of accounting for individual variability. This paper describes a systems biology solution to data complexity through the application of parsimony phylogenetic analysis. Maximum parsimony (MP) provides a data-based modeling paradigm that will permit a priori stratification of the study cohort(s), better assessment of early diagnosis, prognosis, and treatment efficacy within each stratum, and a method that could be used to explore, identify and describe complex human patterning. Copyright © 2012 S. Karger AG, Basel.
• Berg, J. A., Olshansky, E., Shaver, J., Taylor, D., & Woods, N. F. (2012). Women's health in jeopardy: Failure to curb unintended pregnancies. A statement from the AAN Women's Health Expert Panel. Nursing Outlook, 60(3), 163-164.e1.
• Kapella, M. C., Herdegen, J. J., Perlis, M. L., Shaver, J. L., Larson, J. L., Law, J. A., & Carley, D. W. (2011). Cognitive behavioral therapy for insomnia comorbid with COPD is feasible with preliminary evidence of positive sleep and fatigue effects. International Journal of COPD, 6(1), 625-635.
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  PMID: 22162648;PMCID: PMC3232169;Abstract: Background: Many people with COPD report difficulties falling asleep or staying asleep, insufficient sleep duration, or nonrestorative sleep. Cognitive behavioral therapy for i nsomnia (CBT-I) has proved effective not only in people with primary insomnia but also in people with insomnia comorbid with psychiatric and medical illness (eg, depression, cancer, and chronic pain). However, CBT-I has rarely been tested in those with COPD who have disease-related features that interfere with sleep and may lessen the effectiveness of such therapies. The purpose of this study was to determine the feasibility of applying a CBT-I intervention for people with COPD and to assess the impact of CBT-I on insomnia severity and sleep-related outcomes, fatigue, mood, and daytime functioning. Methods: The study had two phases. In Phase 1, a 6-weekly session CBT-I intervention protocol in participants with COPD was assessed to examine feasibility and acceptability. Phase 2 was a small trial utilizing a prospective two-group pre- and post-test design with random assignment to the six-session CBT-I or a six-session wellness education (WE) program to determine the effects of each intervention, with both interventions being provided by a nurse behavioral sleep medicine specialist. Results: Fourteen participants (five in Phase 1 and nine in Phase 2) completed six sessions of CBT-I and nine participants completed six sessions of WE. Participants indicated that both interventions were acceptable. Significant positive treatment-related effects of the CBT-I intervention were noted for insomnia severity (P = 0.000), global sleep quality (P = 0.002), wake after sleep onset (P = 0.03), sleep efficiency (P = 0.02), fatigue (P = 0.005), and beliefs and attitudes about sleep (P = 0.000). Significant positive effects were noted for depressed mood after WE (P = 0.005). Conclusion: Results suggest that using CBT-I in COPD is feasible and the outcomes compare favorably with those obtained in older adults with insomnia in the context of other chronic illnesses. © 2011 Kapella et al, publisher and licensee Dove Medical Press Ltd.
• L., J. (2011). Positive effects of hormone therapy on sleep: Compelling evidence or not?. Menopause, 18(11), 1157-1159.
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  PMID: 22011757;
• Finnegan, L., Shaver, J. L., Zenk, S. N., Wilkie, D. J., & Ferrans, C. E. (2010). The symptom cluster experience profile framework.. Oncology nursing forum, 37(6), E377-386.
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  PMID: 21059571;Abstract: To present the novel Symptom Cluster Experience Profile (SCEP) framework for guiding symptom research in adult survivors of childhood cancers and other subgroups at risk for high symptom burden. Empirically derived model of symptom cluster experience profiles, existing theoretical frameworks, and data-based literature on symptoms and quality of life in adult survivors of childhood cancers. In a previous study, the authors generated a preliminary model to characterize subgroups of adult survivors of childhood cancers with high-risk symptom cluster profiles. The authors developed the SCEP framework, which depicts symptom cluster experiences as subgroup-specific profiles that are driven by multiple sets of risk and protective factors. The risk and protective factors may directly and indirectly contribute to or alleviate symptoms through their effects on systemic stress. Systemic stress instigates and sustains the symptom experience that, in turn, is expressed through negative diffusion into other components of quality of life, such as functional status, general health perceptions, and overall quality of life. The SCEP framework is an initial approach to unbundle the complex heterogeneity that underlies the clustering of symptoms. By measuring a wide range of risk and protective factors in future studies of adult survivors of childhood cancers and other subgroups at risk for high symptom burden, further development and validation of the SCEP framework will occur. The SCEP framework can be used to specify mechanisms underlying symptom cluster profiles and derive interventions targeted to high-risk symptom profiles. Findings from future studies can be translated to risk-based surveillance and symptom management clinical practice guidelines.
• Shaver, J. L. (2010). Ameliorating hot flashes/awakenings in the context of breast cancer treatments. Menopause, 17(5), 889-891.
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  PMID: 20717060;
• Shaver, J. L. (2010). Editorial: Insomnia burden: Definition and link to the menopausal transition. Menopause, 17(1), 12-15.
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  PMID: 20010309;
• Shaver, J. L. (2010). Sleep difficulties: Due to menopause status, age, other factors, or all of the above?. Menopause, 17(6), 1104-1107.
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  PMID: 20975606;
• Shaver, J. L. (2010). Sleep difficulties: due to menopause status, age, other factors, or all of the above?. Menopause (New York, N.Y.), 17(6), 1104-7.
• Finnegan, L., Campbell, R. T., Ferrans, C. E., Wilbur, J., Wilkie, D. J., & Shaver, J. (2009). Symptom Cluster Experience Profiles in Adult Survivors of Childhood Cancers. Journal of Pain and Symptom Management, 38(2), 258-269.
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  PMID: 19535218;PMCID: PMC2782846;Abstract: Although aggressive medical treatment protocols have led to 80% five-year survival rates for most childhood cancer patients, many long-term survivors experience multiple troubling symptoms. Using data from 100 adult survivors of childhood cancers (ACC-survivors), we used latent variable mixture modeling to generate unique subgroups of survivors based on their experiences with a cluster of eight symptoms: lack of energy, worry, pain, difficulty sleeping, feeling irritable, feeling nervous, difficulty concentrating, and feeling sad (as measured by the Memorial Symptom Assessment Scale). We also examined factors that were likely to predict subgroup membership (chronic health conditions [CHCs], health-promoting lifestyle, and demographic variables) and determined the extent to which satisfaction with quality of life (QoL) varied across the subgroups. The final mixture model included three subgroups of ACC-survivors: high symptoms (HS; n = 21), moderate symptoms (MS; n = 45), and low symptoms (LS; n = 34). ACC-survivors who reported at least one CHC were six times as likely to be classified in the HS subgroup as compared with the LS subgroup. Mean health-promoting lifestyle scores were lowest in the HS subgroup and highest in the LS subgroup. Differences in QoL among the subgroups were statistically significant, thus validating that the subgroups were characterized uniquely for identifying those symptoms with highest life impact. To our knowledge, we are the first to identify distinct subgroups of ACC-survivors differentiated by symptom cluster experience profiles. The findings warrant additional research to confirm the subgroup-specific symptom cluster experience profiles in larger studies of ACC-survivors. © 2009 U.S. Cancer Pain Relief Committee.
• Mundinger, M. O., Starck, P., Hathaway, D., Shaver, J., & Woods, N. F. (2009). The ABCs of the Doctor of Nursing Practice: Assessing Resources, Building a Culture of Clinical Scholarship, Curricular Models. Journal of Professional Nursing, 25(2), 69-74.
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  PMID: 19306828;Abstract: The Doctor of Nursing Practice (DNP) degree prepares nurses to provide comprehensive care across sites and over time. It is absolutely crucial-for both patient care and the nursing profession-that broadly recognized standards of competency for these new practitioners be established. The Council for the Advancement of Comprehensive Care has met since 2000 to build consensus on competency standards and a process for certifying these graduates. Deans of five nursing schools discuss their experiences and provide guidance for schools interested in developing DNP programs. © 2009.
• Shaver, J. L. (2009). Editorial: The interface of depression, sleep, and vasomotor symptoms. Menopause, 16(4), 626-629.
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  PMID: 19434005;
• Shaver, J. L., Wilbur, J., Lee, H., Robinson, F. P., & Wang, E. (2009). Self-reported medication and herb/supplement use by women with and without fibromyalgia. Journal of Women's Health, 18(5), 709-716.
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  PMID: 19445618;Abstract: Methods: Using a telephone survey of 434 women who self-reported having and 198 women, who denied having fibromyalgia (FM) (aged 18-80 years), we compared women on self-reported number, major types, and effectiveness of currently taken conventional medications and herbs/supplements. Results: Ninety-three percent of women with FM reported taking at least one medication (1855 total, 499 types, on average 4.6per person) compared with 56% of women without FM (269 total, 172 types, 1.4per person on average). Half (n=217) of the women with FM reported taking antidepressant drugs; more reported selective serotonin reuptake inhibitors (SSRI)-type with moderate effectiveness than tricyclic amines deemed to have strong effectiveness. Few were taking dual uptake inhibitors or the now approved pregabalin. Nearly 30% reported taking nonsteroidal anti-inflammatory drugs (NSAID), which have weak efficacy evidence. Less than 8% of controls reported taking either antidepressants or NSAID. Having FM was associated with these medications plus guaifenesen, anticonvulsants, muscle relaxants, narcotics, other analgesics, and benzodiazepines. Highest effectiveness scores were for opioid narcotics and guaifenesin. Forty-three percent of women with FM reported taking at least one herb/supplement compared with 23% of control women. The most common types were omega esterified fatty acids, glucosamine, and gingko. No particular type distinguished between the groups. Both groups tended to rate overall effectiveness lower for herbs/supplements than for conventional medications. Conclusions: Substantial numbers of women with FM were taking pain medications that often lacked evidence for effectiveness. The variety of medications being taken by women with FM compared with women without FM indicates that there are few medications that consistently provide symptom alleviation for this condition. © 2009, Mary Ann Liebert, Inc.
• Shaver, J. L. (2008). Sleep Disturbed by Chronic Pain in Fibromyalgia, Irritable Bowel, and Chronic Pelvic Pain Syndromes. Sleep Medicine Clinics, 3(1), 47-60.
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  Abstract: In this article evidence is discussed related to the reciprocal features of sleep and pain across three chronic multisymptom conditions, referred to as functional somatic syndromes, that are disproportionately found in women. Light and fragmented polysomnography sleep patterns, although often of lesser severity, match subjective reports of nonrestorative sleep quality and excess risk for sleep-related disorders. Health ecology factors (personal and environmental) contributing to women's vulnerability to these stress-embedded conditions and potential mechanisms related to emotional arousal and inflammatory/immune activation are discussed as linked to pain processing and poor sleep. © 2008 Elsevier Inc. All rights reserved.
• Brooks, B. A., Storfjell, J., Omoike, O., Ohlson, S., Stemler, I., Shaver, J., & Brown, A. (2007). Assessing the quality of nursing work life. Nursing Administration Quarterly, 31(2), 152-157.
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  PMID: 17413509;Abstract: Traditionally, nursing has measured job satisfaction by focusing on employees' likes and dislikes. However, job satisfaction is an unsatisfactory construct to assess either the jobs themselves or employees' feelings about work sinceas much as 30% of the variance explained in job satisfaction surveys is a function of personality, something employers can do little to change. Based on socio-technical systems theory, quality of nursing work life (QNWL) assessments focus on identifying opportunities for nurses to improve their work and work environment while achieving the organization's goals. Moreover, some evidence suggests that improvements in work life are needed to improve productivity. Therefore, assessing QNWL reveals areas for improvement where the needs of both the employees and the organization converge. The purpose of this article was to assess the QNWL of staff nurses using Brooks' Quality of Nursing Work Life Survey. © 2007 Lippincott Williams & Wilkins, Inc.
• Lentz, M. J., Woods, N., Heitkemper, M., Mitchell, E., Henker, R., & Shaver, J. (2007). Ovarian steroids and premenstrual symptoms: A comparison of group differences and intra-individual patterns. Research in Nursing and Health, 30(3), 238-249.
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  PMID: 17514719;Abstract: To examine the relationship of gonadal hormone and symptom patterns across the menstrual cycle, women screened for 2-3 cycles completed an intensive study cycle; 26 had a low-severity symptoms (LS), 20, a premenstrual syndrome (PMS), and 26, a premenstrual magnification pattern (PMM). All completed daily symptom diaries and collected late afternoon urine samples which were assayed for pregnanediol and estradiol for that cycle. The PMS and PMM groups had significantly more positive cross-correlations of pregnanediol and symptoms than the LS group. Women in all groups had similar levels of estradiol and pregnanediol. Women with PMS and PMM patterns responded to progesterone differently than women with LS patterns: thus the former groups may not benefit from hormone therapies. © 2007 Wiley Periodicals, Inc.
• L., J., Wilbur, J., Robinson, F. P., Wang, E., & Buntin, M. S. (2006). Women's health issues with fibromyalgia syndrome. Journal of Women's Health, 15(9), 1035-1045.
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  PMID: 17125422;Abstract: Background: Fibromyalgia syndrome (FMS) involves multiple sensory, somatic, and cognitive symptoms that are bound to affect or be affected by physical and mental health status and behavioral components of daily life. Methods: From a telephone survey of 442 women with and 205 women without FMS as volunteers, data were compared on (1) general health status, (2) reproductive and sleep-related diagnoses, and (3) lifestyle health behaviors. Results: All multiple or logistics regression analyses for group differences were controlled for age, body mass index (BMI), race, employment status, marital status, having a college degree, low household income, and having ever been diagnosed with depression, with a Bonferroni p value correction for multiple indicators. Accordingly, FMS negatively impacted both perceived physical and mental health status, although relatively more so for physical (p < 0.017). Women with FMS were more likely to have had reproductive health or sleep-related diagnoses, including pre-menstrual syndrome, dysmenorrhea, breast cysts, bladder cystitis, sleep apnea, restless leg syndrome, and abnormal leg movements (p < 0.0125). They were calculated to use less than half as many calories per week as control women (689 ± 1293 vs. 1499 ± 1584 kcal/week, p < 0.05) and had more sleep pattern difficulties (p < 0.0125), more negative changes in sexual function (greater odds for 5 of 10 indicators at p < 0.005), and lower alcohol use (odds ratio = 0.39, p < 0.05). Conclusions: Patients with FMS deserve careful assessment for reproductive conditions and sleep-related functional disorders. Besides more research into mechanisms underlying symptoms, intervention testing specifically to alleviate sleep problems, low physical activity levels, and sexual dysfunction should be paramount. © Mary Ann Liebert, Inc.
• Wilbur, J., Shaver, J., Kogan, J., Buntin, M., & Wang, E. (2006). Menopausal transition symptoms in midlife women living with fibromyalgia and chronic fatigue. Health Care for Women International, 27(7), 600-614.
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  PMID: 16844673;Abstract: We aimed to determine how menopausal transition symptoms cluster across 216 midlife women with fibromyalgia, chronic fatigue syndromes (FMS/CFS), or both and subsequently to compare symptom factor severity scores by menopausal status among these women and compare symptom reporting with prior community-based samples of women without obvious illness. We designed a cross-sectional telephone survey of 216 women aged 35 to 55, diagnosed with FMS/CFS, symptomatic in the prior 6 months, and without hysterectomy. Thirty-six of 61 symptoms loaded on five factors: aroused/anxious mood, depressed mood/withdrawal, musculoskeletal, gastrointestinal (GI), and vasomotor. Peri- and postmenopausal women had higher symptom severity scores for musculoskeletal, GI, and vasomotor factors but not mood factors. Symptoms for the women we studied who had FMS/CFS clustered similar to those in previous community-based samples of midlife women without major illness; however, the number of women experiencing symptoms was much higher among our sample. Copyright © Taylor & Francis Group, LLC.
• Shaver, J. (2005). Causes and consequences of the nurse shortage: Developing a solution in Illinois. Journal of Nursing Administration, 35(1), 10-.
• Shaver, J. (2005). Joan Shaver on nurturing leaders.. Canadian journal of nursing leadership, 18(2), 25-27.
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  PMID: 16045052;
• Shaver, J. L. (2005). Interdisciplinary education and practice: Moving from reformation to transformation. Nursing Outlook, 53(2), 57-58.
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  PMID: 15858522;
• Shaver, J. L. (2005). Leadership for health: Building on the past, creating the future. Nursing Outlook, 53(1), 2-3.
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  PMID: 15761392;
• Shaver, J. L. (2005). Making a difference and what a difference communications can make!. Nursing Outlook, 53(5), 217-219.
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  PMID: 16226564;
• Shaver, J. L. (2005). Not at all contrary: How does our garden grow?. Nursing Outlook, 53(6), 266-267.
• Shaver, J. L. (2005). Rebalancing our health care systems paradigm. Nursing Outlook, 53(4), 169-170.
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  PMID: 16115506;
• Shaver, J. L. (2005). The Social Security debate: Considering aging, health disparities, and AAN stance. Nursing Outlook, 53(3), 109-110.
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  PMID: 15988444;
• Cheek, R. E., L., J., & Lentz, M. J. (2004). Variations in sleep hygiene practices of women with and without insomnia. Research in Nursing and Health, 27(4), 225-236.
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  PMID: 15264262;Abstract: Sleep hygiene education is a basic component of behavioral treatment for chronic insomnia, yet the actual sleep hygiene practices of people with insomnia have not been well documented. In this descriptive secondary analysis, midlife women ages 41-55 years with either chronic insomnia (n = 92) or good sleep (n = 29) kept diaries of sleep perceptions and sleep hygiene practices during 6 nights of somnographic monitoring at home. In both groups few reported smoking cigarettes (80%), and many averaged 30 min of exercise per day (∼50%). Very few in either group (
• Cheek, R. E., Shaver, J. L., & Lentz, M. J. (2004). Lifestyle practices and nocturnal sleep in midlife women with and without insomnia. Biological Research for Nursing, 6(1), 46-58.
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  PMID: 15186707;Abstract: Relationships between common lifestyle practices important to sleep hygiene (e.g., smoking cigarettes, drinking alcohol, ingesting caffeine, exercising, bedtimes, getting-up times) and nocturnal sleep have not been documented for women with insomnia in their home environments. This community-based sample of 121 women, ages 40 to 55 years, included 92 women who had experienced insomnia for at least 3 months and 29 women with good-quality sleep. Women recorded lifestyle practices and sleep perceptions (time to fall asleep, awakenings during sleep, feeling rested after sleeping, and overall sleep quality) in diaries while undergoing 6 nights of somnographic sleep monitoring at home. Compared to women with good-quality sleep, women with insomnia reported greater night-to-night variation in perceived sleep variables, poorer overall sleep quality (M = 2.8, SD = 0.7 vs. M = 1.9, SD = 0.5, P < 0.05), and longer times to fall asleep (M = 25 min, SD = 14.2 vs. M = 12.9 min, SD = 5.8, P < 0.05). Correlations between mean individual lifestyle practice scores and mean perceived or somnographic sleep variables were low, ranging from 0 to 0.20. An aggregated sleep hygiene practice score was not associated with either perceived or somnographic sleep variables. Regression analysis using dummy variables showed that combinations of alcohol, caffeine, exercise, smoking, and history of physical disease explained 9% to 19% of variance in perceived or somnographic sleep variables. Lifestyle practices, and combinations thereof, do warrant consideration when assessing or treating insomnia, but these data fail to support a dominant relationship between lifestyle practices and either perceived or somnographic sleep variables. Copyright © 2004 Sage Publications.
• Landis, C. A., Lentz, M. J., Rothermel, J., Buchwald, D., & L., J. (2004). Decreased sleep spindles and spindle activity in midlife women with fibromyalgia and pain. Sleep, 27(4), 741-750.
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  PMID: 15283010;Abstract: Objectives: To compare sleep-spindle incidence (number of spindles per minute of non-rapid eye movement [NREM] stage 2 sleep) and duration, spindle wave time (seconds per epoch in NREM stage 2 sleep), spindle frequency activity, and pain measures (pressure pain threshold, number of tender points, skinfold tenderness) between midlife women with fibromyalgia (FM) and moderate to high pain to a control group of sedentary women without pain. A second goal was to explore the extent to which pain pressure thresholds, age, and depression explain the variance in spindle incidence. Design: A cross-sectional descriptive study. Setting: A university-based sleep research laboratory and a referral clinic for chronic fatigue and pain. Participants: Thirty-seven medication-free women with FM (mean age, 44.9 ± 8 years) and 30 women with self-reported good sleep and no pain (mean age, 44.1 ± 7.7 years) completed a psychiatric interview and the Beck Depression Inventory prior to 2 consecutive nights of polysomnography, with pain measures obtained in the morning. Time domain analysis of spindle incidence and spectral analysis of spindle frequency activity were conducted on night 2 of polysomnography recordings. Interventions: NA. Results: Women with FM had fewer mean spindles per minute of NREM stage 2 sleep and lower mean spindle time per epoch of NREM stage 2 sleep (both P values < .02), but mean spindle duration, although slightly shorter, was not statistically significantly different (P < .06) compared to control women. Women with FM had a lower mean pressure pain threshold, a higher average number of positive tender points, and higher skinfold tenderness compared to control women (all P values < .001). Group differences in spindle frequency activity were found after controlling for age, depression, and psychiatric diagnosis in a general linear model (P < .02). One-way analysis of variance revealed significantly lower spindle activity in the 3 frequency bins (12-12.5 Hz, 13-13.5 Hz, 14-14.5 Hz) at C3 (all P values < .04), Fz (all P values < .02), and Cz (all P values < .02). Finally, after controlling for age and depression, pain pressure threshold significantly predicted spindles per minute and spindle time per epoch of NREM stage 2 sleep (r2 = .26; P < .001). Conclusions: Women with FM and pain have fewer sleep spindles and reduced electroencephalogram power in spindle frequency activity compared to control women of similar age. These data imply that some aspect of thalamocortical mechanisms of spindle generation might be impaired in FM.
• Landis, C. A., Lentz, M. J., Tsuji, J., Buchwald, D., & Shaver, J. L. (2004). Pain, psychological variables, sleep quality, and natural killer cell activity in midlife women with and without fibromyalgia. Brain, Behavior, and Immunity, 18(4), 304-313.
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  PMID: 15157947;Abstract: In women with fibromyalgia (FM), central nervous system (CNS) dysfunction in pain, mood, and sleep processes could be associated with changes in immune system indicators. The primary purpose of this study was to compare pain, psychological variables, subjective and objective sleep quality, lymphocyte phenotypes and activation markers, and natural killer activity (NKA) in midlife women with and without FM. A secondary purpose was to explore relationships among these variables in a step-wise regression. Subjects had pain pressure tender points assessed, completed a psychiatric interview and questionnaires (Beck Depression Inventory, SCL-90, Profile of Mood States, subjective sleep), and underwent polysomnograhic assessment for two consecutive nights. Lymphocyte phenotypes, activation markers, and NKA were assessed from blood drawn the morning after sleep laboratory night 2. Compared to controls, women with FM had lower pain thresholds, more psychological distress, higher depression scores, and reduced subjective and objective sleep quality. They also had fewer NK cells (p
• Lee, K. A., Landis, C., Chasens, E. R., Dowling, G., Merritt, S., Parker, K. P., Redeker, N., Richards, K. C., Rogers, A. E., Shaver, J. F., Umlauf, M. G., & Weaver, T. E. (2004). Sleep and chronobiology: Recommendations for nursing education. Nursing Outlook, 52(3), 126-133.
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  PMID: 15197361;Abstract: The discipline of nursing is concerned with human responses in illness and wellness at individual, family, and community levels of practice. Sleep and circadian rhythms are biological processes that can influence wellness and illness, or can be altered by illness and adverse environments. As yet, however, there is no established curriculum for sleep or chronobiology in undergraduate or graduate nursing education. This paper provides a consensus by expert nurses in the field of sleep and circadian rhythm disorders that can be used for undergraduate and graduate levels of nursing education as well as a basis for beginning research and practice on sleep and health consequences of sleep loss.
• Shaver, J. (2004). Envisioning novel and meaningful collaborations: Crucial leadership needed. Nursing Outlook, 52(5), 223-224.
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  PMID: 15499309;
• Shaver, J. (2004). Reflecting on disparities, abuse of power and failure of leadership. Nursing Outlook, 52(4), 162-163.
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  PMID: 15328500;
• Shaver, J. (2004). What about an "E" campaign?. Nursing Outlook, 52(6), 275-276.
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  PMID: 15614265;
• Shaver, J. L. (2004). AAN organizational age and stage: Reflections. Nursing Outlook, 52(1), 3-4.
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  PMID: 15014372;
• Shaver, J. L. (2004). Fibromyalgia syndrome in women. Nursing Clinics of North America, 39(1), 195-204.
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  PMID: 15062736;Abstract: Many more women than men experience the chronically fatiguing condition of fibromyalgia syndrome (FMS), a growing diagnosis in the United States. Estimates are that upwards of 2% to 6% of adults have been diagnosed with FMS, and at high societal costs. In this article, common manifestations are described to guide assessment and various lines of research are explored as a basis for understanding contributing factors and potential treatments for FMS and other chronic disorders, such as chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), and temporomandibular disorders (TMD), and the effectiveness of current treatment options.
• Shaver, J. L. (2004). Improving the health of communities: The position of nursing. Nursing Outlook, 52(3), 116-117.
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  PMID: 15197359;
• Shaver, J. L. (2004). The new order: Enacting the will to govern well. Nursing Outlook, 52(2), 71-72.
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  PMID: 15073585;
• Thomas, K. A., Burr, R., Wang, S., Lentz, M. J., & Shaver, J. (2004). Axillary and thoracic skin temperatures poorly comparable to core body temperature circadian rhythm: results from 2 adult populations.. Biological research for nursing, 5(3), 187-194.
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  PMID: 14737919;Abstract: Data from 2 separate studies were used to examine the relationships of axillary or thoracic skin temperature to rectal temperature and to determine the phase relationships of the circadian rhythms of these temperatures. In study 1, axillary skin and rectal temperatures were recorded in 19 healthy women, 21 to 36 years of age. In study 2, thoracic skin and rectal temperatures were recorded in 74 healthy women, 39 to 59 years of age. In both studies, temperatures were recorded continuously for 24 h while subjects carried out normal activities. Axillary and thoracic probes were insulated purposely to prevent ambient effects. Cosinor analysis was employed to estimate circadian rhythm mesor, amplitude, and acrophase. In addition, correlations between temperatures at various measurement sites were calculated and agreement determined. The circadian timing of axillary and skin temperature did not closely approximate that of rectal temperature: the mean acrophase (clock time) for study 1 was 18:57 h for axillary temperature and 16:12 h for rectal; for study 2, it was 03:05 h for thoracic and 15:05 h for rectal. Across individual subjects, the correlations of axillary or thoracic temperatures with rectal temperatures were variable. Results do not support the use of either axillary or skin temperature as a substitute for rectal temperature in circadian rhythm research related to adult women.
• Landis, C. A., Frey, C. A., Lentz, M. J., Rothermel, J., Buchwald, D., & L, J. (2003). Self-reported sleep quality and fatigue correlates with actigraphy in midlife women with fibromyalgia.. Nursing research, 52(3), 140-147.
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  PMID: 12792254;Abstract: BACKGROUND: Limited data are available on the relationship between self-reported sleep quality, fatigue, and behavioral sleep patterns in women with fibromyalgia (FM). OBJECTIVES: To compare self-reported sleep quality, fatigue, and behavioral sleep indicators obtained by actigraphy between women with FM and sedentary women without pain, and to examine relationships among these variables. METHODS: Twenty-three women with FM (M = 47.3, +/- 6.7 years) and 22 control women (M = 43.5, +/- 8.2 years) wore an actigraph on the nondominant wrist for 3 consecutive days at home. Each day women reported bedtimes, rise times, and ratings of sleep quality and fatigue in a diary. Self-reported sleep quality, fatigue, and indicators of sleep quality obtained from actigraphy (e.g., total sleep time, sleep efficiency, sleep latency, wake after sleep onset, and fragmentation index) were averaged. The Mann Whitney U test was used to assess group differences. Pearson Product Moment Correlation was used to evaluate relationships between sleep quality and fatigue, and among sleep quality, fatigue, and actigraphy sleep indicators. RESULTS: Women with FM reported poorer sleep quality and more fatigue compared to controls (both p
• Shaver, J. L. (2003). President's message: Charting a course and course corrections: Challenges in leadership. Nursing Outlook, 51(6), 251-252.
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  PMID: 14688757;
• L., J., Johnston, S. K., Lentz, M. J., & Landis, C. A. (2002). Stress exposure, psychological distress, and physiological stress activation in midlife women with insomnia. Psychosomatic Medicine, 64(5), 793-802.
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  PMID: 12271110;Abstract: Objective: The objective of this study was to describe perceived and polysomnograhic (PSG) sleep patterns and determine whether stress exposure, psychological distress, and physiological stress activation differed among midlife women with psychophysiologic-type (PP-type) or subjective only-type (SO-type) insomnia or no insomnia. Methods: Women had their sleep monitored, collected urine samples, and completed questionnaires in a week-long field study, and 53 women met criteria for insomnia types or no insomnia based on reported sleep quality and PSG sleep efficiency. Results: As expected, women with PP-type insomnia were found to have the lowest sleep efficiency, took longer to fall asleep, had more wakefulness after sleep onset, and had more fragmented sleep. Perceptions of stress exposure, either for major or minor events, did not differ among groups. Despite there being no differences in perceived stress exposure, women with both types of insomnia scored higher on psychological distress (SCL-90R), especially on the somatization subscale, than women with no insomnia. Of the physiological stress activation indicators tested, a morning-to-evening difference in urinary cortisol statistically differed across the groups (p < .005). Women in the PP-type insomnia group had the highest levels of urinary cortisol in an early morning urine sample. Conclusions: These data provide support for the hypothesis that, in midlife women, cognitive or emotional arousal with chronic stress neuroendocrine activation underlies chronic insomnia, particularly the PP-type.
• Shaver, J. L. (2002). Women and sleep. Nursing Clinics of North America, 37(4), 707-718.
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  PMID: 12587369;Abstract: Naturally fluctuating hormones (menstrual cycle, through pregnancy or menopausal transition) are not related to marked sleep disturbances in women. It is likely, however, that subsets of women will display a central nervous system vulnerability to hormonal fluctuations so that sleep disturbances manifest as a part of a complex of discomforting symptoms. Sleep is impacted directly through the circadian system or brain sleep regulation or through the development of concurrent functional changes and symptoms. Women are susceptible to sleep-related disorders that are also common in men, such as primary insomnia and SBD although the contributing factors and manifestations may not be the same. General summary of practice implications: The prevalence of sleep problems, especially in midlife women, warrants attention to assessment. It is important to rule out possible primary sources of insomnia, such as medical (eg, chronic illness), psychiatric (eg, mental illness) and pharmacologic types, as well as contextual factors (eg, divorce, job loss, bereavement). Screening for insomnia, sleep-related breathing disorders, narcolepsy, and other sleep-related disorders can be done quickly, but gender differences in common manifestations must be considered. Effective nursing interventions for sleep problems fall into the realms of behavioral coaching, or education for self-care sleep improvement, and screening for referral of serious sleep-related disorders. Treatments for insomnia will depend on the type (acute or chronic, primary or secondary), context within which the insomnia occurs (social and menopausal status), and the severity of the daytime functional impairment. Acute insomnia treatments can include short-term prescriptions of sleeping pills, eg, zolpidem tartrate (Ambien®, Searle, Chicago) or short acting benzodiazepines, to break a cycle of sleeplessness, but behavioral treatments are foundational for sustained improvements. Behavioral treatments can be readily incorporated into primary or tertiary care nursing practice for insomnia unrelated to SDB or other sleep disorders. These include counseling people to engage in good sleep hygiene and to ritualize the bedtime routine, or in more severe cases of insomnia, to practice stimulus control or sleep restriction (see Table 1 for summary). Screening and recognition of chronic, severe insomnia, SDB, narcolepsy, or periodic limb movements during sleep warrant referral to an accredited sleep disorders center to help prevent the negative health outcomes that can emanate from disturbed sleep. © 2002 Elsevier Science (USA). All rights reserved.
• Sugrue, N. M., Kenner, C., & Shaver, J. (2002). A partnership management model for a nurse-run clinic in medically underserved rural areas: health policy initiative.. Nursing Outlook, 50(1), 36-37.
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  PMID: 12136789;
• Carnes, M., Vandenbosche, G., Agatisa, P. K., Hirshfield, A., Dan, A., Shaver, J. L., Murasko, D., & McLaughlin, M. (2001). Using women's health research to develop women leaders in academic health sciences: The national centers of excellence in women's health. Journal of Women's Health and Gender-Based Medicine, 10(1), 39-47.
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  PMID: 11224943;Abstract: While the number of women entering U.S. medical schools has risen substantially in the past 25 years, the number of women in leadership positions in academic medicine is disproportionately small. The traditional pathway to academic leadership is through research. Women's health research is an ideal venue to fill the pipeline with talented women physicians and scientists who may become academic leaders in positions where they can promote positive change in women's health as well as mentor other women. The Office on Women's Health (OWH) in the U.S. Department of Health and Human Services has contracted with 18 academic medical centers to develop National Centers of Excellence in Women's Health. Emphasizing the integral link between women's health and women leaders, each of the Centers of Excellence must develop a leadership plan for women in academic medicine as part of the contract requirements. This paper describes the training programs in women's health research that have developed at five of the academic medical centers: the University of Wisconsin, Magee Women's Hospital, the University of Maryland, Medical College of Pennsylvania Hahnemann University, and the University of Illinois at Chicago. We discuss some of the challenges faced for both initiation and future viability of these programs as well as criteria by which these programs will be evaluated for success.
• Johnston, S. K., Landis, C. A., Lentz, M. J., & Shaver, J. L. (2001). Self-reported nap behavior and polysomnography at home in midlife women with and without insomnia. Sleep, 24(8), 913-919.
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  PMID: 11766161;Abstract: Study Objectives: To describe self-reported nap behavior and relationships among nap history, nap behavior during the study, indicators of subjective and objective insomnia, and self-reported daytime sleepiness from data previously obtained in a week-long field study of sleep in midlife women with and without insomnia. Design: Descriptive/comparative secondary analysis. Setting: Individual homes of the participants. Participants: Midlife women (mean age 46±4 years) with self-reported insomnia (n=101) and women with adequate sleep (n=30). Interventions: N/A. Measurements and Results: Sleep patterns were assessed by polysomnography (PSG), daily diaries, and a sleep history form. Although all women were requested not to nap, 47% of the women reported nap behavior during the study. Strong relationships were observed between a history of daytime naps and nap behavior (??2=25.63, p≤.001), and a history of feeling sleepy or struggling to stay awake during the daytime (i.e., sleepiness) and nap behavior (??2=18.05, p≤.O01) during the study. There was also a modest significant (p≤.05) correlation (r=.25) between tiredness and nap duration during the study. There were no statistical differences in sleep variables between the napping and non-napping groups. In the napping group, there were no differences between women with sleep efficiency < 85% (objective insomnia) and those with sleep efficiency >85%. Conclusions: Habitual nap behavior may be indicative of daytime sleepiness in women with insomnia, but it is not necessarily related to subjective or objective measures of insomnia. Women who routinely nap may be unable to refrain from napping during the daytime in long-term research studies.
• Landis, C. A., Lentz, M. J., Rothermel, J., Riffle, S. C., Chapman, D., Buchwald, D., & L., J. (2001). Decreased nocturnal levels of prolactin and growth hormone in women with fibromyalgia. Journal of Clinical Endocrinology and Metabolism, 86(4), 1672-1678.
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  PMID: 11297602;Abstract: Fibromyalgia (FM) is a complex syndrome, primarily of women, characterized by chronic pain, fatigue, and sleep disturbance. Altered function of the somatotropic axis has been documented in patients with FM, but little is known about nocturnal levels of PRL. As part of a laboratory study of sleep patterns in FM, we measured the serum concentrations of GH and PRL hourly from 2000-0700 h in a sample of 25 women with FM (mean, 46.9 ± 7.6 yr) and in 21 control women (mean, 42.6 ± 8.1 yr). The mean (±SEM) serum concentrations (micrograms per L) of GH and of PRL during the early sleep period were higher in control women than in patients with FM [GH, 1.6 ± 0.4 vs. 0.6 ± 0.2 (P < 0.05); PRL, 23.2 ± 2.2 vs. 16.9 ± 2.0 (P < 0.025)]. The mean serum concentrations of GH and PRL increased more after sleep onset in control women than in patients with FM [GH, 1.3 ± 0.4 vs. 0.3 ± 0.2 (P < 0.05); PRL, 16.2 ± 2.4 vs. 9.7 ± 1.5 (P < 0.025)]. Sleep efficiency and amounts of sleep or wake stages on the blood draw night were not different between groups. There was a modest inverse relationship between sleep latency and PRL and a direct relationship between sleep efficiency and PRL in FM. There was an inverse relationship between age and GH most evident in control women. Insulin-like growth factor I levels were not different between the groups. These data demonstrate altered functioning of both the somatotropic and lactotropic axes during sleep in FM and support the hypothesis that dysregulated neuroendocrine systems during sleep may play a role in the pathophysiology of FM.
• Zenk, S. N., L., J., Peragallo, N., Fox, P., & Chávez, N. (2001). Use of herbal therapies among midlife Mexican women. Health Care for Woman International, 22(6), 585-597.
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  PMID: 12141849;Abstract: The cultural traditions of Mexican women living in the United States make it likely that some women promote their health and manage their symptoms using various herbal therapies, yet we know little about this phenomenon. The purpose of this study was to describe and compare midlife Mexican women living in the U.S. who were or were not using herbal therapies with regard to the extent of their acculturation, beliefs about herbs, and factors associated with their utilization of health services. A convenience sample of 30 Mexican women between the ages of 40 and 56 years completed face-to-face interviews in either English or Spanish. Nearly half reported using herbal therapies. With the exception of positive beliefs about herbs, we found few differences between herbal users and nonusers on acculturation or access to, and satisfaction with, health services. Although acculturation did not appear to influence whether the women used herbal therapies, it did relate to the types of herbs selected. Women most commonly reported using herbs popular in traditional Mexican culture, including manzanilla (chamomile), savila (aloe vera), ajo (garlic), uña de gato (cat's claw), and yerba buena (spearmint).
• Lewis, L. L., Shaver, J. F., Woods, N. F., Lentz, M. J., Cain, K. C., Hertig, V., & Heidergott, S. (2000). Bone resorption levels by age and menopausal status in 5,157 women. Menopause, 7(1), 42-52.
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  PMID: 10646703;Abstract: Objective: The purpose of this study was to describe bone resorption activity using a biochemical marker according to the categories of age, menopausal status, and selected drug/supplement use in middle-aged and elderly community-based women. Design: This was a cross-sectional study that assessed urinary cross-linked N-telopeptide of type I collagen (NTx) and used self-report data to group women as premenopausal (Pre), perimenopausal (Peri), postmenopausal without hormone replacement therapy (Post), and postmenopausal with hormone replacement therapy (HRT). Results: Mean NTx values were found to be significantly different by group and controlling for age (p = 0.001), with post hoc tests showing all pairwise group comparisons as significantly different (p = 0.001), except that the Pre and HRT groups were not significantly different. Both the Peri and the Post NTx levels were significantly higher than the Pre and the HRT groups'. NTx values in the Peri group varied with age-the youngest Peri women were similar to Pre women, and the oldest Peri women were similar to Post women. Significantly lower NTx levels were found only in the Post (p = 0.009) and HRT (p < 0.001) groups using diuretics compared with nonuse and only in the HRT group using calcium supplements compared with nonuse (p = 0.006). No differences by thyroid use were found. With a biochemical marker, the results showed that bone resorption activity differences could be demarcated in women according to age, estimated menopausal stage, and selected drug/supplement use. Conclusions: These results support the usefulness of NTx assessment for indicating bone resorption activity and therefore the potential for osteoporosis or for monitoring the efficacy of antiresorptive therapies.
• Shaver, J. L. (2000). Educating the nursing workforce in 2000 and beyond.. Seminars for nurse managers, 8(4), 197-204.
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  PMID: 12029669;Abstract: Changes in the health care delivery system have comparable impacts on both nursing practice and education, such that tomorrow's nursing practice would best emanate from innovative partnerships between leaders in practice and education. For the foreseeable future, an expert nursing workforce is needed in an expanded form, but an array of challenges to maintaining this workforce are evident. Recent and continuing scientific and technologic advances in health care make the matching of practice and education to evolving trends paramount. Regardless of what the future holds, generative leadership in any realm of practice is essential to move our profession into the forefront of health care.
• Shaver, J. L., & Zenk, S. N. (2000). Sleep disturbance in menopause. Journal of Women's Health and Gender-Based Medicine, 9(2), 109-118.
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  PMID: 10746514;Abstract: Sleep problems (i.e., insomnia) affect midlife women as they approach and pass through menopause at rates higher than at most other stages of life. The purpose of this article is to critically review what is known about insomnia (perceived poor sleep) and physiologically assessed sleep, as well as sleep-related disordered breathing (SDB), in women according to menopausal status and the role of hypothalamic-pituitary-ovarian (HPO) hormones. Self-report evidence that sleep difficulties are related to the hormonal changes of menopause is mixed. Data from studies in which sleep was physiologically measured reveal that sleep problems appear corequisite with hot flashes and sweats. Results are difficult to compare across studies because of varying methodologies in how sleep quality and patterns were assessed and how age cohorts and menopausal status were defined. The risk of SDB increases with age, although women are less susceptible at any age than men. As with men, snoring, obesity, and high blood pressure are clear risk factors. Some women may be underdiagnosed for SDB, as they have somewhat different symptom manifestations than men. Usually, frank apnea is not as evident. Primary care clinicians should be mindful of the potential for SDB in women who are obese, have high blood pressure, are cognizant of snoring, and report morning headaches and excessive daytime sleepiness. Improved care will result from consistently incorporating sleep insomnia assessments into practice as a basis for referring to sleep centers as necessary or prescribing sleep-enhancing behavioral and pharmacological treatments.
• Lentz, M. J., Landis, C. A., Rothermel, J., & Shaver, J. L. (1999). Effects of selective slow wave sleep disruption on musculoskeletal pain and fatigue in middle aged women. Journal of Rheumatology, 26(7), 1586-1592.
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  PMID: 10405949;Abstract: Objective. To determine whether disrupted slow wave sleep (SWS) would evoke musculoskeletal pain, fatigue, and an alpha electroencephalograph (EEG) sleep pattern. We selectively deprived 12 healthy, middle aged, sedentary women without muscle discomfort of SWS for 3 consecutive nights. Effects were assessed for the following measures: polysomnographic sleep, musculoskeletal tender point pain threshold, skinfold tenderness, reactive hyperemia (inflammatory flare response), somatic symptoms, and mood state. Methods. Sleep was recorded and scored using standard methods. On selective SWS deprivation (SWSD) nights, when delta waves (indicative of SWS) were detected on EEG, a computer generated tone (maximum 85 decibels) was delivered until delta waves disappeared. Musculoskeletal tender points were measured by dolorimetry; skinfold tenderness was assessed by skin roll procedure; and reactive hyperemia was assessed with a cotton swab test. Subjects completed questionnaires on bodily feelings, symptoms, and mood. Results. On each SWSD night, SWS was decreased significantly with minimal alterations in total sleep time, sleep efficiency, and other sleep stages. Subjects showed a 24% decrease in musculoskeletal pain threshold after the third SWSD night. They also reported increased discomfort, tiredness, fatigue, and reduced vigor. The flare response (area of vasodilatation) in skin was greater than baseline after the first, and again, after the third SWSD night. However, the automated program for SWSD did not evoke an alpha EEG sleep pattern. Conclusion. Disrupting SWS, without reducing total sleep or sleep efficiency, for several consecutive nights is associated with decreased pain threshold, increased discomfort, fatigue, and the inflammatory flare response in skin. These results suggest that disrupted sleep is probably an important factor in the pathophysiology of symptoms in fibromyalgia.
• Heitkemper, M., Beth, A., Shaver, J., Lentz, M. J., & Jarrett, M. E. (1998). Self-Report and Polysomnographic Measures of Sleep in Women with Irritable Bowel Syndrome. Nursing Research, 47(5), 270-277.
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  PMID: 9766455;Abstract: Background: Women who report chronic gastrointestinal symptoms compatible with a diagnosis of irritable bowel syndrome (IBS) frequently report sleep disturbances. Objectives: The purposes of this study were to (a) compare self-reported and polysomnographic indicators of sleep quality in women with IBS symptoms (IBS-SX, n = 16) and controls (n = 16); (b) examine the relationship between the indicators of sleep quality; and (c) determine the relationship between sleep indicators and psychological distress. Method: The women slept in a laboratory for 2 consecutive nights. Polysomnographic measurements were recorded during sleep, and a sleep questionnaire was completed upon awakening each morning. Psychological distress was measured with the Symptom Checklist-90-R during the initial interview. Results: Women in the IBS-SX group reported significantly greater numbers of awakenings during sleep (p = .008) and had a longer latency to REM sleep (p = .04) than did the controls. Self-reported and polysomnographic indicators were more highly correlated in the control group than in the IBS-SX group. In the IBS-SX group, the greater the psychological distress, the less alert (rs = .419) and rested (rs = .564) the women felt in the morning and the more time the women spent in stages 3 and 4 sleep (rs = .479) and less in stage 2 (rs = -.447) and REM (rs = -.414) sleep. In the control group, psychological distress was not significantly associated with self-reported measures but was significantly associated with the number of awakenings (rs = .506) and time in stages 3 and 4 sleep (rs = -.677). Conclusions: Although the women in the IBS-SX group reported significantly more awakenings, the weak relationship between self-reported and polysomnographic indicators suggests that clinicians must keep in mind that further assessments may be necessary.
• Shaver, J. L. (1998). Increased cervical cytologic smear access through increased capacity [1]. Journal of Reproductive Medicine for the Obstetrician and Gynecologist, 43(11), 1005-1006.
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  PMID: 9839272;
• Woods, N. F., Lentz, M. J., Mitchell, E. S., Heitkemper, M., Shaver, J., & Henker, R. (1998). Perceived Stress, Physiologic Stress Arousal, and Premenstrual Symptoms: Group Differences and Intra-Individual Patterns. Research in Nursing and Health, 21(6), 511-523.
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  PMID: 9839796;Abstract: The purpose of this study was to examine evidence for perceived stress, hypothalamic-pituitary-adrenal, and autonomic nervous system involvement in premenstrual symptoms. Women with a low severity (LS, n = 40), premenstrual syndrome (PMS, n = 22), and premenstrual magnification symptom patterns (PMM, n = 26) rated perceived stress, turmoil, and fluid retention symptoms for one entire cycle. Daily late afternoon urine samples were assayed for epinephrine, norepinephrine, and cortisol. Using multivariate analysis of variance analyses, we found significant group and cycle phase and group by phase interaction effects for perceived stress. There were no group or cycle phase differences in cortisol, epinephrine, and norepinephrine. Intraindividual analyses using cross-correlation techniques revealed a positive time lagged relationship between perceived stress and norepinephrine and cortisol levels across all groups. Only women with a PMS pattern demonstrated perceived stress leading epinephrine levels. Cortisol, epinephrine, and norepinephrine levels led symptoms for all groups with one exception: there was no cross-correlation between epinephrine and turmoil for the PMS group. Perceived stress led both types of symptoms, regardless of group, and symptoms also led stress. The results provide evidence for a unique relationship between epinephrine, perceived stress, and symptoms for women with PMS, and for a reciprocal relationship between stress and symptoms for each of the groups. © 1998 John Wiley & Sons, Inc.
• Woods, N. F., Lentz, M. J., Mitchell, E. S., Shaver, J., & Heitkemper, M. (1998). Luteal Phase Ovarian Steroids, Stress Arousal, Premenses Perceived Stress, and Premenstrual Symptoms. Research in Nursing and Health, 21(2), 129-142.
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  PMID: 9535405;Abstract: The purpose of this study was to examine the relationships among perceived stress, ovarian steroids (estradiol and pregnanediol), stress arousal indicators (cortisol, catecholamines) and premenstrual symptoms (turmoil, fluid retention). Women (N = 74) with low symptom severity (LS), premenstrual syndrome (PMS), or premenstrual magnification (PMM) symptom patterns provided daily urine samples over one cycle and recorded their symptoms and perceived stress levels in a health diary. Multiple regression analysis was used to test models of premenstrual symptoms in separate analyses for women with the LS and PMS symptom patterns and the LS and PMM symptom patterns. Data from the LS and PMS groups revealed that greater stress ratings accounted for turmoil symptoms and higher luteal phase cortisol levels for fluid retention symptoms. For LS and PMM groups, lower luteal phase norepinephrine levels, higher global stress ratings, and a more gradual drop in estradiol premenses accounted for turmoil symptoms. Premenses norepinephrine and epinephrine levels and premenses stress ratings accounted for fluid retention. These findings support an important relationship among perceived stress, stress arousal indicators, and premenstrual symptoms that differs for women with a PMS and PMM symptom pattern. © 1998 John Wiley & Sons, Inc.
• Conway-Welch, C., Fogel, C., Holm, K., Killien, M., Marion, L., McBride, A., Shaver, J., Simms, L., Swanson, K., Taylor, D., & Woods, N. (1997). Women's health and women's health care: Recommendations of the 1996 AAN Expert Panel on Women's Health. Nursing Outlook, 45(1), 7-15.
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  PMID: 9139266;Abstract: The Expert Panel on Women's Health of the American Academy of Nursing has studied the need for transformative change in women's health services and provides recommendations to facilitate such change in the current system of health care and in nursing education, practice, and policy so that women's health needs may be met more effectively.
• L., J., Lentz, M., Landis, C. A., Heitkemper, M. M., Buchwald, D. S., & Woods, N. F. (1997). Sleep, Psychological Distress, and Stress Arousal in Women with Fibromyalgia. Research in Nursing and Health, 20(3), 247-257.
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  PMID: 9179178;Abstract: The purpose of this investigation was to compare self-reported sleep quality and psychological distress, as well as somnographic sleep and physiological stress arousal, in women recruited from the community with self-reported medically diagnosed fibromyalgia (FM) to women without somatic symptoms. Eleven midlife women with FM, when compared to 11 asymptomatic women, reported poorer sleep quality and higher SCL-90 psychological distress scores. Women with FM also had more early night transitional sleep (stage 1) (p < 0.01), more sleep stage changes (p < 0.03) and a higher sleep fragmentation index (p < 0.03), but did not differ in α-EEG-NREM activity (a marker believed to accompany FM). No physiological stress arousal differences were evident. Less stable sleep in the early night supports a postulate that nighttime hormone (e.g., growth hormone) disturbance is an eitiologic factor but, contrary to several literature assertions, α-EEG-NREM activity sleep does not appear to be a specific marker of FM. Further study of mechanisms is needed to guide treatment options. © 1997 John Wiley & Sons, Inc.
• Lee, E. N., Mankad, S., Shaver, J., Poveda, H., Gayowski, T., Marino, I. R., & Hertzog, D. (1997). Transjugular intrahepatic portosystemic shunt (TIPS) complicated by complete heart block [6]. Anaesthesia and Intensive Care, 25(3), 312-313.
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  PMID: 9209624;
• Woods, N. F., Lentz, M., Mitchell, E. S., Heitkemper, M., & Shaver, J. (1997). PMS after 40: Persistence of a Stress-Related Symptom Pattern. Research in Nursing and Health, 20(4), 329-340.
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  PMID: 9256879;Abstract: The purpose of this study was to compare women over 40 years of age with premenstrual syndrome (PMS) to women with a low-severity (LS) symptom pattern with respect to physiologic indicators of stress arousal and response, stress hormone arousal, stressful life circumstances anger, self- and social control, and interpersonal sensitivity. Women with PMS experienced more negative life events, more difficulty with anger, and more concerns about self-and social control, than women with an LS pattern. These experiences were coupled with increased physiologic arousal and stress responses (skin conductance and muscle tension levels) and relatively higher norepinephrine levels than for women with an LS pattern, but with dampened cardiovascular responses to stressors. As they age, women with a PMS symptom pattern demonstrate persistent differences in stress arousal and response from women with an LS pattern. © 1997 John Wiley & Sons, Inc.
• Heitkemper, M., Jarrett, M., Cain, K., Shaver, J., Bond, E., Woods, N. F., & Walker, E. (1996). Increased urine catecholamines and cortisol in women with irritable bowel syndrome. American Journal of Gastroenterology, 91(5), 906-913.
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  PMID: 8633579;Abstract: Objectives: There are few data on the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis in individuals with chronic GI symptoms. The current study was designed to describe and compare urine catecholamine (norepinephrine, epinephrine) and cortisol levels in women diagnosed with irritable bowel syndrome (IBS-patients), women who report similar symptom levels but had not sought health care services (IBS-nonpatients; IBS-NP), and asymptomatic (control) women. Methods: Seventy-three women (24 IBS; 24 IBS- NP; 25 controls) were interviewed for demographic, GI, gynecological, and psychological data and then followed fur two menstrual cycles with a daily health diary. Urine samples were obtained in the evening and morning at specific phases across two menstrual cycles. Results: Women in the IBS group had significantly higher PM and AM urine norepinephrine levels. Urine epinephrine and cortisol levels were also generally higher in women with IBS. Differences in neuroendocrine indicators of arousal were not accounted for by differences in demographic variables, lifestyle characteristics, menstrual distress, or average daily measures of anxiety or depression. Conclusions: Increases in indicators of sympathetic nervous system activation in women seeking health care for IBS may reflect greater symptom distress or may contribute to increased symptom distress.
• Dougherty, C. M., & Shaver, J. F. (1995). Psychophysiological responses after sudden cardiac arrest during hospitalization. Applied Nursing Research, 8(4), 160-168.
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  PMID: 8579348;Abstract: A sample of 21 sudden cardiac arrest (SCA) survivors were interviewed every 48 hours during hospitalization to determine emotional, cognitive, and physiological parameters of recovery. On the average, SCA survivors were not excessively anxious, depressed, angry, or confused during hospitalization, but they did report high levels of denial and uncertainty. The two most predominant cognitive impairments at the time of hospital discharge were loss of short-term memory and construction ability. Both the number of cardiac arrhythmias and the types of interventions used to manage them decreased as hospital discharge approached. © 1995 W.B. Saunders Company.
• Heitkemper, M. M., Jarrett, M., Cain, K. C., Shaver, J., Walker, E., & Lewis, L. (1995). Daily gastrointestinal symptoms in women with and without a diagnosis of IBS. Digestive Diseases and Sciences, 40(7), 1511-1519.
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  PMID: 7628275;Abstract: This study compared daily gastrointestinal symptoms and stool characteristics across two menstrual cycles, and recalled bowel symptoms and psychological distress in women with irritable bowel syndrome (IBS, N=22), IBS nonpatients (IBS-NP, N=22), and controls (N =25). Daily reports of abdominal pain, bloating, intestinal gas, constipation, and diarrhea did not differ significantly between the IBS and IBS-NP groups but both groups reported significantly higher symptoms than the control group. Stool consistencies was significantly looser in the IBS group relative to the control group. Menstrual cycle effects on symptoms were noted in all the groups. There were no significant differences in psychological distress between women with IBS, and IBS-NP, but both groups reported significantly higher global distress than the control group. The lack of difference between the IBS and IBS-NP groups in contrast to the results of others, can be understood in terms of differences in recruitment strategies. © 1995 Plenum Publishing Corporation.
• Jarrett, M., Heitkemper, M. M., & Shaver, J. F. (1995). Symptoms and self-care strategies in women with and without dysmenorrhea.. Health care for women international, 16(2), 167-178.
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  PMID: 7759347;Abstract: We compared the self-reports of women who reported either none-mild (N = 34) or moderate-extreme (N = 27) pain from uterine cramping regarding, (a) gastrointestinal, perimenstrual, and other symptoms during the 5 days before and after the beginning of menstrual flow; (b) smoking, alcohol use, exercise behaviors, and number of reported stressors; and (c) self-care strategies used for symptom management. Although there were significant differences between the two groups in reported symptoms, there were no significant between groups differences in smoking, alcohol use, exercise behaviors, and number of stressors reported. Despite the number of symptoms reported, relatively few self-care strategies were used. The most commonly reported strategy was the use of medication for cramping pain. The results confirm prior observations that dysmenorrhea is associated with a variety of symptoms and extend our understanding of how women manage these symptoms.
• Meyer, K., Dimond, M., Shaver, J., Canfield, K., Mookerjee, V., Mannin, M., Mookerjee, R., & Abbott, P. (1995). The 'Learnmore' project: information acquisition solutions for the long-term care information system.. Medinfo. MEDINFO, 8 Pt 1, 276-279.
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  PMID: 8591171;Abstract: Research and development efforts on Long Term Care (LTC) information systems are only beginning to appear in the literature. For the past two years, a small, interdisciplinary team of researchers (the Learnmore Team) have designed information solutions to information acquisition problems in LTC systems. This paper provides an overview of the Learnmore Team's proposed solutions to acquisition problems experienced by end-users (clinicians, students, and patients) and human experts. Solutions addressing information acquisition costs of integrated expert systems are also discussed. Critical issues and experiences gained during the development of these solutions are presented.
• Shaver, J. L., & Landis, C. A. (1995). Continuing education program. Integrating an understanding of sleep knowledge into your practice. Part 2. Helping people manage primary insomnia (continuing education credit).. The American nurse, 27(1), 22-23.
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  PMID: 7856961;
• Henker, R., & Shaver, J. (1994). Understanding the febrile state according to an individual adaptation framework.. AACN clinical issues in critical care nursing, 5(2), 186-193.
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  PMID: 7767813;Abstract: Fever is a common problem in the critically ill that is often treated by nurses. Decisions regarding treatment of fever would be more informed if based upon research related to fever. The authors, in this article, present an individual adaptation framework for conceptualizing the components of the febrile state important to practice, and review some of the existing research related to development, assessment, and treatment of fever.
• L., J. (1994). Beyond hormonal therapies in menopause. Experimental Gerontology, 29(3-4), 525-528.
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  Abstract: Women in midlife often access health care providers with reports of hot flashes, sleep problems, and depressed mood, perhaps directly or indirectly associated with menopausal hormone shifts. Evidence that stress conditions have profound effects on reproductive function is suggestive that stress adaptation is important to understanding menopausal symptoms. This paper briefly outlines salient interactions between neurohormonal mechanisms of stress responses and reproduction known to be affected by exercise, dietary intake and cognitive strategies, as a basis for advocating research that tests these therapies as alternatives or complements to drug therapies for menopausal symptoms. Reductions in hot flashes and positive mood and sleep changes are evident with such therapies but specific study in midlife women is lacking, Specifically, exercise (type, duration, intensity, and timing), dietary intake (type and amount of macronutrients or micronutrients, fiber, and timing), and cognitive techniques (type, amount, duration, and timing), deserve testing for effects on catecholamines, serotonin, opioids, and other neuromediators; ovarian hormones and related steroids, as well as gonadotropins; and circulating neuromediator precursors in midlife women. Further outcomes for testing include body weight, temperature regulation, menstrual cycle regulation, fertility, mood state, eating and sleeping patterns, social patterns, disease risk factors, and symptoms.
• Shaver, J. L. (1994). Beyond hormonal therapies in menopause. Experimental Gerontology, 29(3-4), 469-476.
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  PMID: 7925765;Abstract: Women in midlife often access health care providers with reports of hot flashes, sleep problems, and depressed mood, perhaps directly or indirectly associated with menopausal hormone shifts. Evidence that stress conditions have profound effects on reproductive function is suggestive that stress adaptation is important to understanding menopausal symptoms. This paper briefly outlines salient interactions between neurohormonal mechanisms of stress responses and reproduction known to be affected by exercise, dietary intake and cognitive strategies, as a basis for advocating research that tests these therapies as alternatives or complements to drug therapies for menopausal symptoms. Reductions in hot flashes and positive mood and sleep changes are evident with such therapies but specific study in midlife women is lacking, Specifically, exercise (type, duration, intensity, and timing), dietary intake (type and amount of macronutrients or micronutrients, fiber, and timing), and cognitive techniques (type, amount, duration, and timing), deserve testing for effects on catecholamines, serotonin, opioids, and other neuromediators; ovarian hormones and related steroids, as well as gonadotropins; and circulating neuromediator precursors in midlife women. Further outcomes for testing include body weight, temperature regulation, menstrual cycle regulation, fertility, mood state, eating and sleeping patterns, social patterns, disease risk factors, and symptoms. © 1994.
• Shaver, J. L. (1994). What the new council structure means for you.. The American nurse, 26(2), 10-11.
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  PMID: 8116961;
• Shaver, J. L., & Landis, C. A. (1994). Continuing education program: integrating and understanding of sleep knowledge into your practice (continuing education credit).. The American nurse, 26(9), 16-17.
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  PMID: 7985869;
• Shaver, J. L., & Rodgers, A. E. (1994). Continuing education program: integrating an understanding of sleep knowledge into your practice. Part 2. Screening for sleep-related disorders: sleep apnea and narcolepsy (continuing education credit).. The American nurse, 26(10), 24-25.
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  PMID: 7810927;
• Shaver, J. L., & Paulsen, V. M. (1993). Sleep, psychological distress, and somatic symptoms in perimenopausal women.. The Family practice research journal, 13(4), 373-384.
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  PMID: 8285088;Abstract: OBJECTIVE: Self-report and somnographic data from 135 volunteer, disease-free, women (37-59 years) were used to determine the prevalence of perceived poor sleep and to compare women with and without "poor" sleep on menopausal status, somnographic sleep, psychological distress, and somatic symptom cluster frequencies. METHODS: Data from identical measures done on two groups of perimenopausal-age women, one recruited for menopausal age and the other for same age but sleep problems plus controls, were tested using a two-way analysis of variance for the main effects of recruitment group and the presence or absence of "poor" sleep as well as the joint effects of both. RESULTS: "Poor" sleep was reported by more than one-third of the women, but menopausal status and perceived sleep quality were not statistically related. Women with "poor" sleep took longer to fall asleep, spent longer in bed, and had higher scores for psychological distress and for four out of five somatic symptom clusters (p < or = 0.03), compared to women with "good" sleep. CONCLUSION: In sum, midlife women reporting poor sleep are likely to have trouble falling asleep and to have higher psychological distress and somatic symptoms, especially musculoskeletal discomfort and fatigue, coinciding with their perceived poor sleep.
• Shaver, J. L. (1992). Nurse researchers show strength on council.. The American nurse, 24(8), 26-.
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  PMID: 1519819;
• Steele, B., & Shaver, J. (1992). The dyspnea experience: nociceptive properties and a model for research and practice.. ANS. Advances in nursing science, 15(1), 64-76.
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  PMID: 1519912;Abstract: Dyspnea has been defined as the unpleasant sensation of difficult breathing and the reaction to that sensation. Dyspnea research, however, has largely used a unidimensional, sensory model of dyspnea devoid of the affective and motivational dimensions that uniquely characterize this sensation in clinical populations. Dyspnea might be more comprehensively viewed as a nociceptive phenomenon which, like pain, has affective dimensions expressed as distress in response to aversiveness. A multidimensional, ecologic model of the dyspnea experience is presented that incorporates nociceptive sensation properties and is suggestive of new directions for dyspnea research uniquely relevant to nursing science.
• Woods, N. F., & Shaver, J. F. (1992). The evolutionary spiral of a specialized center for women's health research.. Image--the journal of nursing scholarship, 24(3), 223-228.
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  PMID: 1521851;
• Paulsen, V. M., & Shaver, J. L. (1991). Stress, support, psychological states and sleep. Social Science and Medicine, 32(11), 1237-1243.
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  PMID: 2068606;Abstract: A stress-support model incorporating indicators of life events, social support and SCL-90 measures of psychological distress was hypothesized to affect both reported and objective (somnographic) sleep. To determine the effects of these antecedents on sleep among 69 mid-life women, two models were tested, using both partial correlations and path analysis. Of all the measures of life events and social support examined in this study only negative LEs and contacts with non-supportive persons were associated (positively) with psychological distress, differentially explaining between 9% and 19% of the variance in each of five SCL-90 subscales. Both negative life events and contacts with non-supportive persons influenced depression and the SCL-90 PST index, whereas only negative life events affected anxiety, phobic anxiety and paranoid ideation. Anxiety, depression and the PST index, as indicators of psychological distress, had direct inverse effects on reported sleep with significant adjusted R2 values ranging from 10% to 16%. The model did not hold for somnographic sleep. The factors which are likely to contribute to the absence of an observed relationship between psychological distress and somnographic sleep are discussed. © 1991.
• Shaver, J. L., Giblin, E., & Paulsen, V. (1991). Sleep quality subtypes in midlife women. Sleep, 14(1), 18-23.
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  PMID: 1811314;Abstract: Eighty-two midlife women (40-59 years) were classified as poor or good sleepers according to either self-reported sleep quality or a sleep efficiency index (SEI) criterion, for comparison of wakefulness, fragmentation and other somnographic sleep variables; as well as psychological (SCL-90) and somatic symptom distress. When classified solely by self-report, the good and poor sleeper groups did not differ on any somnographic variables but self-declared poor sleepers had higher psychological distress scores than good sleepers (p ≤ 0.01). When classified solely by the SEI criterion, the good and poor sleepers did not differ on psychological distress but, as expected, differed on various somnographic wakefulness as well as rapid eye movement and stage 2 sleep variables. Further analysis of four subgroups derived by combining objective and subjective, good and poor sleep scores indicated that 15% of this sample (n = 12) perceived but had no objective evidence of poor sleep, and this group scored highest in psychological distress. Only seven women perceived poor sleep in concert with demonstrating low SEI. They scored highest in menopausal symptoms but not in general psychological distress.
• Simpson, T., & Shaver, J. (1991). A comparison of hypertensive and nonhypertensive coronary care patients' cardiovascular responses to visitors. Heart and Lung: Journal of Critical Care, 20(3), 213-220.
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  PMID: 1709628;Abstract: Patients with and without hypertension in a coronary care unit (n = 24) were compared with respect to cardiovascular responses to both a family visit and an interview by an investigator. Variables for each of the four cardiovascular indicators (systolic blood pressure, diastolic blood pressure, heart rate, and premature ventricular contractions) included the value before, the highest value during, the lowest value during, and the value after each social interaction condition. The highest group means for systolic blood pressure and heart rate were significantly higher for patients with hypertension than for patients without hypertension under both the interview and visit conditions. Differences in cardiovascular responses were not significantly greater for family visits than for interviews for patients with hypertension compared with those without hypertension. Thus, although hypertensive patients had greater cardiovascular reactivity to both social interaction conditions than nonhypertensive patients in the coronary care unit, family visits were no more physiologically stressful than a comparative interaction condition.
• Costeff, H., Holm, V. A., Ruvalcaba, R., & Shaver, J. (1990). Growth hormone secretion in Prader-Willi syndrome. Acta Paediatrica Scandinavica, 79(11), 1059-1062.
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  PMID: 2267923;Abstract: Integrated 12-hour growth hormone secretion studies, peak growth hormone response to clonidine provocation. Somatomedin-C levels, T-4 and TSH levels were studied in six growth-retarded children with the Prader-Willi syndrome, of whom five had a 15 q-karyotype. Only one of the subjects was obese. All showed abnormally low growth hormone secretion. None achieved a nocturnal peak above 10 μg/l, none had a mean nocturnal level over 1.8, and none showed a level above 8 μg/l after clonidine provocation. These findings contrasted with normal TSH in all and normal T-4 in five. These findings suggest that the poor linear growth in the Prader-Willi syndrome is caused by a true deficiency of growth hormone secretion, and that the low growth hormone levels observed in such cases are not an artifact of obesity.
• Heitkemper, M. M., Bond, E. F., Shaver, J. F., & Georges, J. M. (1990). Menstrual cycle factors related to increased gastric contractile response to tube feeding. Journal of Parenteral and Enteral Nutrition, 14(6), 634-639.
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  PMID: 2125649;Abstract: Evidence exists that the ovarian hormones have a modulating effect on gastrointestinal (GI) motility, yet details are sketchy and little attention has been paid to the effect that fluctuating hormone levels might have on women who are receiving enteral feedings. This study compared gastric motility indices in response to tube feedings at two points in the menstrual cycle, concurrently measured ovarian hormone levels, and described three potentially related factors (ie, GI symptoms, uterine cramping pain, reports of daily stressors). Intragastric motility responses to enteral feedings were obtained on 28 women (aged 19-37) during menses and midfollicular phases of two menstrual cycles. Intragastric pressure changes were monitored by an open-tipped cannula method at rest, during and after tube feeding (Ensure, 240 ml at 8 ml/min). Serum estradiol and progesterone levels were measured by radioimmunoassay. Women completed a daily diary of symptoms and stressors throughout the two menstrual cycles. Results showed that intragastric pressure amplitudes and frequencies were higher at menses compared with midfollicular recordings. At menses, prefeeding and feeding gastric pressure amplitudes were positively correlated with uterine cramping pain and GI symptoms (ie, nausea). At menses, postfeeding contraction frequencies were also correlated with uterine cramping pain. At midfollicular phase, progesterone levels correlated with gastric motility indices; number of stressors indirectly correlated with gastric motility indices. These data suggest that gastric responses to enteral feeding are influenced by menstrual cycle phase.
• Lee, K. A., Shaver, J. F., Giblin, E. C., & Woods, N. F. (1990). Sleep patterns related to menstrual cycle phase and premenstrual affective symptoms. Sleep, 13(5), 403-409.
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  PMID: 2287852;Abstract: An ovulatory menstrual cycle is characterized by fluctuating levels of progesterone. Progesterone, a gonadal hormone known for its soporific and thermogenic effects, is present in negligible levels prior to ovulation and in high levels after ovulation. To describe and compare sleep patterns in relation to ovulatory cycles and premenstrual mood state, sleep was monitored in healthy women at two phases of the menstrual cycle. Results indicated that rapid-eye-movement (REM) latency was significantly shorter during the postovulatory (luteal) phase compared to the preovulatory (follicular) phase, but there was no significant difference in latency to sleep onset or the percentage of REM sleep. While there were no menstrual cycle phase differences in the percentages of various sleep stages, the women with negative affect symptoms during the premenstruum demonstrated significantly less delta sleep during both menstrual cycle phases in comparison with the asymptomatic subjects.
• Simpson, T., & Shaver, J. (1990). Cardiovascular responses to family visits in coronary care unit patients. Heart and Lung: Journal of Critical Care, 19(4), 344-351.
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  PMID: 1695213;Abstract: Changes in four cardiovascular indicators: systolic blood pressure, diastolic blood pressure, heart rate, and premature ventricular contractions, were studied as responses to family visits and a 10-minute interview with the investigator in 24 patients in a coronary care unit. By use of a repeated-measures design, data were compared by multivariate analysis of variance. No significant differences were found between the group mean systolic and diastolic blood pressure, heart rate, and rate of premature ventricular contractions during family visits and interviews. The lowest systolic and diastolic blood pressure values were significantly lower during the visit than during the interview, suggesting that the visit had a calming effect on patients. Although the highest heart rate was significantly higher during the visit than during the interview, the difference was clinically inconsequential. The wide variance in premature ventricular contraction values suggests individual variation in responses, but no significant differences were found between visits and interviews. Although family visits were no more physiologically stressful than a comparative social interaction, select subsamples of patients with cardiac disease should be studied for more specific reaction patterns.
• Heitkemper, M. M., & Shaver, J. F. (1989). Nursing research opportunities in enteral nutrition. Nursing Clinics of North America, 24(2), 415-426.
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  PMID: 2498852;Abstract: The concepts of individual adaptations, environmental, and person factors have been suggested as components of a framework for considering existing and potential investigations of enteral feeding as a therapeutic modality. Much of the work regarding adaptations to enteral feeding have described the pathophysiological and experiential responses of individuals - that there is less emphasis on the physiological and behavioral responses is evident in the literature. Also, little investigation has been focused on the environmental risk factors or the person vulnerability factors that are associated with less than optimal adaptations to enteral feeding. However, it is the understanding of all three of these aspects that will lead to comprehensive strategies for promoting satisfactory adaptations. To date, the majority of clinical therapeutic studies have focused on obviating or managing untoward reactions to enteral feeding by manipulating environmental physical factors. Certainly, more needs to be done, particularly with respect to temporal and rhythmicity considerations. However, there is an obvious lack of information about manipulating social circumstances or person factors (such as, knowledge deficit) for therapeutic ends. Examination of the multiple dimensions of patient responses to enteral nutrition modalities, the interaction of these various dimensions (concentrating on the social and person), and the physical elements is congruent with the holistic and caring nature of nursing practice and should guide future study.
• Heitkemper, M. M., Miller, J. C., & Shaver, J. F. (1989). The effect of restricted liquid feeding on gastrointestinal and adrenocortical variables in rats.. Western journal of nursing research, 11(1), 34-46.
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  PMID: 2728418;
• Shaver, J. L., & Giblin, E. C. (1989). Sleep.. Annual review of nursing research, 7, 71-93.
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  PMID: 2669893;
• Heitkemper, M. M., Shaver, J. F., & Mitchell, E. S. (1988). Gastrointestinal symptoms and bowel patterns across the menstrual cycle in dysmenorrhea. Nursing Research, 37(2), 108-113.
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  PMID: 3347518;Abstract: Gastrointestinal (GI) functional indicators and symptoms across the menstrual cycle were examined in three groups of women: dysmenorrheic (n=15), non-pill-taking nondysmenorrheic (n=10), and nondysmenorrheic taking birth control pills (BCPs) (n=9). Group assignment was based on the reported presence or absence of moderate to severe menstrual cramps in a GI Health Diary which subjects kept for two menstrual cycles. Stool consistencies and frequencies and GI symptoms were also recorded in this diary. Menstrual cycle phase significantly, p=.03, influenced stool consistencies for the sample as a whole with the loosest stools at menses. Reports of stomach pain were higher, p
• Shaver, J., Giblin, E., Lentz, M., & Lee, K. (1988). Sleep patterns and stability in perimenopausal women. Sleep, 11(6), 556-561.
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  PMID: 3148991;Abstract: Women between the ages of 40 and 59 years were classified as pre-, peri-, and postmenopausal, with and without hot flash symptoms, for comparison of somnographic sleep variables. Few differences in sleep variables were noted between the groups. However, peri- and postmenopausal women experiencing hot flashes (symptomatic) tended to have lower sleep efficiencies than those not experiencing hot flashes. As well, rapid-eye-movement (REM) latency was longer (p < 0.05) in the symptomatic women (x̄ = 94.2 min) than in the nonsymptomatic women (x̄ = 71.4 min). Although an age difference existed between the menopausal status groups, it was less than a decade and a main group effect for sleep efficiency and REM latency was seen while controlling for age and/or depression.
• Simmons, L., Heitkemper, M., & Shaver, J. (1988). Gastrointestinal function during the menstrual cycle.. Health care for women international, 9(3), 201-209.
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  PMID: 3417576;
• Heitkemper, M. M., & Shaver, J. F. (1987). Adrenalectomy and pentagastrin effects on gastrointestinal cholinergic enzyme activities. Biology of the Neonate, 51(5), 277-285.
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  PMID: 3593809;Abstract: The present study examined the effects of pentagastrin and adrenalectomy on choline acetyltransferase (ChAT) and acetylcholine esterase (AChE), enzymes which synthesize and degrade acetylcholine in the rat gastrointestinal tract. Adrenalectomized and non-adrenalectomized rats, 14 and 21 days old, were treated with either pentagastrin (250 μg/kg i.p.) or saline for 7 days. Rats were sacrificed at 21 and 28 days of age. Adrenalectomy- and pentagastrin-treated 21-day-old rats had greater ChAT activities than those treated with pentagastrin alone, while AChE activities were higher in the pentagastrin-treated group. Adrenalectomy- and pentagastrin-treated 28-day-old rats had lower levels of activity as compared to pentagastrin-treated rats. The adrenal gland does appear to influence the response of cholinergic enzyme activities to pentagastrin.
• Shaver, J. F., Woods, N. F., Wolf-Wilets, V., & Heitkemper, M. M. (1987). Menstrual experiences. Comparisons of dysmenorrheic and nondysmenorrheic women.. Western journal of nursing research, 9(4), 423-444.
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  PMID: 3433737;
• Heitkemper, M. M., & Shaver, J. F. (1986). Pentagastrin on neurotransmitter enzyme activities in the rat gastrointestinal tract. American Journal of Physiology - Gastrointestinal and Liver Physiology, 250(4), 13/4.
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  PMID: 3963198;Abstract: The effects of three doses (5, 100, and 250 μg/kg) of pentagastrin on the activities of choline acetyltransferase (ChAT) and acetylcholine esterase (AChE), the neurotransmitter enzymes that synthesize and degrade acetylcholine, and monoamine oxidase (MAO), the degradation enzyme for catecholamines, were investigated. Enzyme activities were assayed in 6 gastrointestinal segments of 21- and 28-day-old and adult rats. All animals were injected intraperitoneally for 7 days with pentagastrin, and the results were compared with age-matched controls receiving saline for 7 days. Plasma and adrenal corticosterone levels were measured. No consistent differences in adrenocortical variables existed between pentagastrin- and saline-treated animals. Similarly, no consistent pentagastrin dose responses of ChAT, AChE, and MAO activities were evident. However, at the highest dose pentagastrin generally produced increases in ChAT activities in 21- and 28-day-old rats, while producing decreases in AChE and MAO activities in 21-day-old rats and increases in 28-day-old animals. There were few significant differences in enzyme activities in adult rats receiving pentagastrin as compared to saline.
• Shaver, J. (1986). High touch nursing in a high tech world.. The Canadian nurse, 82(5), 16-19.
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  PMID: 3634653;
• Heitkemper, M. M., & Shaver, J. (1985). Effect of pentagastrin (P) and adrenalectomy on gastrointestinal (GI) neurotransmitter enzyme activities. Federation Proceedings, 44(3), No. 1196.
• Shaver, J. F. (1985). A biopsychosocial view of human health. An effective approach to nursing care must encompass all factors that act, either singly or in combination, on human health. Nursing Outlook, 33(4), 186-191.
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  PMID: 3848821;Abstract: A biopsychosocial perspective fits the human health response/care model of nursing and has the potential for creating useful basic knowledge for generating both descriptive and prescriptive theories from a nursing perspective. The benefits of such an approach include more comprehensive, individualized assessment and diagnostic potential, expanded correlate patterns to predict health vulnerability and risk, expanded therapeutic options and greater potential for targeting therapy and individualizing prescriptions - all of which would improve the professional practice of nursing.
• Shaver, J. F., & Woods, N. F. (1985). Concordance of perimenstrual symptoms across two cycles.. Research in nursing & health, 8(4), 313-319.
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  PMID: 2934771;Abstract: The prevalence of perimenstrual symptoms usually is based on reports for one menstrual cycle; the consistency of symptoms across cycles is ignored. The purpose of this investigation was to determine perimenstrual symptoms reported concordantly for two menstrual cycles in a group of 63 presumably healthy women reporting symptoms in health diaries over 2 months. There were only nine symptoms for each of the menstrual and premenstrual phases reported by the same woman across both cycles. Furthermore, concordance of perimenstrual symptom reporting across the two cycles was significant only for backache (kappa = .636, p less than .0001), headache (kappa = .849, p less than .001), and cramps (kappa = .899, p less than .001) in the menstruum and for backache (kappa = 0.123, p less than .0001), cold sweats (kappa = .500, p less than .0001), fatigue (kappa = .135, p less than .0001), depression (kappa = .268, p less than .0002), and tension (kappa = .320, p less than .0001) in the premenstruum. Several symptoms showed high prevalence during the remainder of the cycle which might contribute to the lack of concordance. These data imply that prevalence estimates based on only one menstrual cycle may be inaccurate overall and inadequate as baseline or followup estimates by which to evaluate therapeutic intervention.
• Heitkemper, M. M., & Shaver, J. L. (1984). The effect of pentagastrin on gastrointestinal enzyme activities. Federation Proceedings, 43(4), no. 4614.
• Shaver, J. F. (1982). The basic mechanisms of fever: considerations for therapy.. Nurse Practitioner, 7(9), 15-19.
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  PMID: 7145241;Abstract: In response to threat, particularly the invasion of microorganisms, body temperature rises, a condition called fever. This occurs as phagocytic cells in the body are activated to secrete substances which generate a multitude of host defense responses. Evidence is presented that this response is likely adaptive for the individual and fever acts to synergistically support the responses. Implications for practice are that the attenuation of fever by clinical interventions could limit the defense mechanisms for the individual and a more effective therapeutic goal might be to keep body temperature within certain limits. Developing knowledge about the host defense response and fever mechanisms will suggest supportive therapeutic options for testing.
• Shaver, J., Shaver, J. L., Sanders, J. B., Mitchell, P. H., Marotta, S. F., Knowlton, C. B., Heitkemper, M. M., Cunningham, S. G., & Burr, R. L. (1982). Applying physiologic data to nursing therapeutics.. Western journal of nursing research, 4(3), suppl 101-6. doi:10.1177/019394598200400320
• Shaver, J. L., & Stirling, C. (1978). Ouabain binding to renal tubules of the rabbit. Journal of Cell Biology, 76(2), 278-292.
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  PMID: 10605438;PMCID: PMC2109977;Abstract: It is well known that ouabain, a specific inhibitor of Na-K ATPase-dependent transport, interferes with renal tubular salt reabsorption. In this study, we employed radiochemical methods to measure the kinetics of [3H]ouabain binding to slices of rabbit renal medulla and high resolution quantitative autoradiography to determine the location and number of cellular binding sites. The kinetics obeyed a simple bimolecular reaction with an association constant of 2.86 ± 0.63 SD x 103 M-1 min-1 and a dissociation constant of 1.46 x 10-3 min-1, yielding an equilibrium binding constant of 0.51 x 10-6 M. Binding was highly dependent upon temperature. At a concentration of 10-6 M, the rate of accumulation between 25°C and 35°C exhibited a Q10 of 1.8. At 0°C the rate of ouabain dissociation was negligible. The specificity of binding was demonstrated with increasing potassium concentrations. At a concentration of 1 μM, 6 mM, and 50 mM K+ produced a 2.5- and 7-fold decrease, respectively, in the rate of ouabain accumulation observed at zero K+. Binding was completely inhibited by 1 mM strophanthin K. The major site of ouabain binding was the thick ascending limb; little or no binding observed in thin limbs and collecting ducts. Moreover, binding was confined to the basolateral membranes. From autoradiographic grain density measurements, it was estimated that each cell contains over 4 x 106 ouabain binding sites or Na-K ATPase molecules. These results taken together with physiological and biochemical observations suggest that Na-K ATPase plays a key role in salt reabsorption by this segment.

Presentations

• Shaver, J. L. (2021, December). On the Horizon – Nursing Education Ventures. U of Washington, School of Nursing.
• Shaver, J. L. (2021, November). Re-imagining Governance. Washington State University.
• Shaver, J. L. (2021, September). Shifting toward the Future. Biobehavioral Nursing and Health Informatics Dept. - U of Washington School of Nursing.

Reviews

• Shaver, J. L. (2015. Sleep and Menopause: A Narrative Review(pp 899-915). Menpause 22(8).