Loneliness and Hypervigilance to Social Threats in Adults

A current theoretical model (Cacioppo & Hawkley, 2009) proposes that lonely people are hypervigilant (i.e. on high alert) to social threats in the social environment. This leads to attention, memory, and confirmatory biases, which undermine the opportunity to develop positive social relationships. This thesis outlines a series of six studies that systematically examine the hypervigilance to social threat hypothesis in loneliness using adult samples. The studies described in this thesis make an original contribution to the loneliness literature and uses different experimental paradigms to examine whether lonely adults are hypervigilant to social threats that are visually presented. Studies 1 and 5 bridge the gap in the current knowledge to examine the visual attention processing of lonely adults to social threat depicted as social rejection stimuli using eye-tracker methodology. Study 2 investigates whether loneliness is associated to eye-gaze and emotion processing utilising a cognitive paradigm. Studies 3 and 4 extend the literature on visual attention processing of lonely adults to investigate the processing of emotional information depicted as facial expressions using eye-tracker methodology. Specifically, study 3 uses a paradigm of four different emotional expressions (i.e. anger, afraid, happy and neutral), and study 4 utilises a face in a crowd paradigm for which different ratios of happy to angry faces were presented. Study 6 extends the work on hypervigilance to social threats depicted as social rejection stimuli to examine how these stimuli are processed by lonely adults in the brain using EEG methodology. Findings from study 1 and 5 suggest that lonely adults show visual attentional biases to social threat stimuli linked to social rejection. Specifically, study 1 findings indicate that lonely adults show a hypervigilance-avoidance pattern of processing towards social rejection stimuli, whilst study 5 findings indicate that lonely adults show disengagement difficulties when processing social rejection stimuli. Study 2 indicates that loneliness is not associated to eye-gaze and emotion processing. Study 3 and 4 provide support that lonely adults are more attentive to angry facial expressions presented as static images. Findings from study 6 indicate that lonely adults detect and process social threats quickly compared to non-social threats in the brain. As outlined in Cacioppo and Hawkley’s theoretical model, the findings of this thesis support the idea that loneliness is related to initial cognitive processes. Specifically, lonely adults are hypervigilant to social threats depicted as angry facial expressions and social rejection stimuli. Thus, the thesis examines an important process within the model. The findings of the thesis can be used to inform ideas for future academic and intervention work in the loneliness field

The Patient Needs Assessment in Cancer Care: Identifying Barriers and Facilitators to Implementation in the UK and Canada

Purpose Personalised information and support can be provided to cancer survivors using a structured approach. Needs assessment tools such as the Holistic Needs Assessment (HNA) in the United Kingdom and the Comprehensive Problem and Symptom Screening (COMPASS) questionnaire in Canada are recommended for use in practice; however, they are not widely embedded into practice. The study aimed to determine the extent to which nurses working in cancer care in the UK and Manitoba value NA and identify any barriers and facilitators they experience. Method Oncology nurses involved in the care of cancer patients in the UK (n=110) and Manitoba (n=221) were emailed a link to an online survey by lead cancer nurses in the participating institutions. A snowball technique was used to increase participation across the UK resulting in 306 oncology nurses completing the survey in the UK and 116 in Canada. Results Participants expressed concerns that these assessments were becoming bureaucratic “tick-box exercises” which did not meet patients’ needs. Barriers to completion were time, staff shortages, lack of confidence, privacy and resources. Facilitators were privacy for confidential discussions, training, confidence in knowledge and skills, and referral to resources. Conclusion Many busy oncology nurses completed this survey demonstrating the importance they attach to HNAs and COMPASS. The challenges faced with implementing these assessments into everyday practice require training, time, support services and an appropriate environment. It is vital that the HNA and COMPASS are conducted at optimum times for patients to fully utilise time and resources

Loneliness Across the Life Span

Most people have experienced loneliness and have been able to overcome it to reconnect with other people. In the current review, we provide a life-span perspective on one component of the evolutionary theory of loneliness—a component we refer to as the reaffiliation motive (RAM). The RAM represents the motivation to reconnect with others that is triggered by perceived social isolation. Loneliness is often a transient experience because the RAM leads to reconnection, but sometimes this motivation can fail, leading to prolonged loneliness. We review evidence of how aspects of the RAM change across development and how these aspects can fail for different reasons across the life span. We conclude with a discussion of age-appropriate interventions that may help to alleviate prolonged lonelines

Factors affecting thrombolysis in acute stroke: longer door-to-needle (DTN) time in younger people? [Abstract No. 53]

Introduction: Shortening the time to delivery of IV thrombolysis improves patient outcomes and reduces adverse events. This research aimed to explore patient and service delivery factors that increase or decrease DTN time for thrombolysis. Method: We conducted a Service Evaluation from July 2011 to March 2013, using stroke data from SINAP and DASH databases. Data was provided by 6 acute trusts in Lancashire and Cumbria which used telemedicine, and 11 stroke services within the North East of England which instead used face-to-face. Our investigation concentrates on admissions to hospital occurring out of routine working hours, when resources are particularly constrained. Descriptive and inferential analyses, focusing on multivariate Cox regressions models selected using a forward stepwise approach, were then carried out to determine which factors impacted on DTN time, our main outcome variable. Results: After testing alternative specifications, our final model included these potential risk factors: mode of thrombolysis decision-making (either face-to-face or telemedicine); hospital; age; sex. Our results show that DTN time was strongly influenced by patient’s age (p<0.01), with older people receiving thrombolysis more quickly. Among the statistically significant variables, type of hospital (p<0.001) appeared to affect DTN times, together with patient’s sex (p¼0.01), suggesting that males had shorter DTN times. Conclusion: Older age was associated with shorter DTN times, with this effect being independent of other factors. Therefore, our research suggests that age played a predominant role in the delivery of thrombolysis, rather than solely through the choice of assessing acute strokethrough face-to-face or telemedicine

Hydration and nutrition care practices in stroke: findings from the UK and Australia

BACKGROUND: Dehydration and malnutrition are common in hospitalised patients following stroke leading to poor outcomes including increased mortality. Little is known about hydration and nutrition care practices in hospital to avoid dehydration or malnutrition, and how these practices vary in different countries. This study sought to capture how the hydration and nutrition needs of patients' post-stroke are assessed and managed in the United Kingdom (UK) and Australia (AUS).AIM: To examine and compare current in-hospital hydration and nutrition care practice for patients with stroke in the UK and Australia.METHODS: A cross-sectional survey was conducted between April and November 2019. Questionnaires were mailed to stroke specialist nurses in UK and Australian hospitals providing post-stroke inpatient acute care or rehabilitation. Non-respondents were contacted up to five times.RESULTS: We received 150/174 (86%) completed surveys from hospitals in the UK, and 120/162 (74%) in Australia. Of the 270 responding hospitals, 96% reported undertaking assessment of hydration status during an admission, with nurses most likely to complete assessments (85%). The most common methods of admission assessment were visual assessment of the patient (UK 62%; AUS 58%), weight (UK 52%; AUS 52%), and body mass index (UK 47%; AUS 42%). Almost all (99%) sites reported that nutrition status was assessed at some point during admission, and these were mainly completed by nurses (91%). Use of standardised nutrition screening tools were more common in the UK (91%) than Australia (60%). Similar proportions of hydration management decisions were made by physicians (UK 84%; AUS 83%), and nutrition management decisions by dietitians (UK 98%; AUS 97%).CONCLUSION: Despite broadly similar hydration and nutrition care practices after stroke in the UK and Australia, some variability was identified. Although nutrition assessment was more often informed by structured screening tools, the routine assessment of hydration was generally not. Nurses were responsible for assessment and monitoring, while dietitians and physicians undertook decision-making regarding management. Hydration care could be improved through the development of standardised assessment tools. This study highlights the need for increased implementation and use of evidence-based protocols in stroke hydration and nutrition care to improve patient outcomes.</p

Predictors of recognition of out of hospital cardiac arrest by emergency medical services call handlers in England: a mixed methods diagnostic accuracy study

Abstract: Background: The aim of this study was to identify key indicator symptoms and patient factors associated with correct out of hospital cardiac arrest (OHCA) dispatch allocation. In previous studies, from 3% to 62% of OHCAs are not recognised by Emergency Medical Service call handlers, resulting in delayed arrival at scene. Methods: Retrospective, mixed methods study including all suspected or confirmed OHCA patients transferred to one acute hospital from its associated regional Emergency Medical Service in England from 1/7/2013 to 30/6/2014. Emergency Medical Service and hospital data, including voice recordings of EMS calls, were analysed to identify predictors of recognition of OHCA by call handlers. Logistic regression was used to explore the role of the most frequently occurring (key) indicator symptoms and characteristics in predicting a correct dispatch for patients with OHCA. Results: A total of 39,136 dispatches were made which resulted in transfer to the hospital within the study period, including 184 patients with OHCA. The use of the term ‘Unconscious’ plus one or more of symptoms ‘Not breathing/Ineffective breathing/Noisy breathing’ occurred in 79.8% of all OHCAs, but only 72.8% of OHCAs were correctly dispatched as such. ‘Not breathing’ was associated with recognition of OHCA by call handlers (Odds Ratio (OR) 3.76). The presence of key indicator symptoms ‘Breathing’ (OR 0.29), ‘Reduced or fluctuating level of consciousness’ (OR 0.24), abnormal pulse/heart rate (OR 0.26) and the characteristic ‘Female patient’ (OR 0.40) were associated with lack of recognition of OHCA by call handlers (p-values < 0.05). Conclusions: There is a small proportion of calls in which cardiac arrest indicators are described but the call is not dispatched as such. Stricter adherence to dispatch protocols may improve call handlers’ OHCA recognition. The existing dispatch protocol would not be improved by the addition of further terms as this would be at the expense of dispatch specificity

Oral Care Practices in Stroke: Findings from the UK and Australia

Aims: To examine current practice, perceptions of healthcare professionals and factors affecting provision for oral care post-stroke in the UK and Australia. Background: Poor oral care has negative health consequences for people post-stroke. Little is known about oral care practice in hospital for people post-stroke and factors affecting provision in different countries. Design: A cross-sectional survey. Methods: Questionnaires were mailed to stroke specialist nurses in UK and Australian hospitals providing inpatient acute or rehabilitation care post-stroke. The survey was conducted between April and November 2019. Non-respondents were contacted up to five times. Results: Completed questionnaires were received from 150/174 (86%) hospitals in the UK, and 120/162 (74%) in Australia. A total of 52% of UK hospitals and 30% of Australian hospitals reported having a general oral care protocol, with 53% of UK and only 13% of Australian hospitals reporting using oral care assessment tools. Of those using oral care assessment tools, 50% of UK and 38% of Australian hospitals used local hospital-specific tools. Oral care assessments were undertaken on admission in 73% of UK and 57% of Australian hospitals. Staff had received oral care training in the last year in 55% of UK and 30% of Australian hospitals. Inadequate training and education on oral care for pre-registration nurses were reported by 63% of UK and 53% of Australian respondents. Conclusion: Unacceptable variability exists in oral care practices in hospital stroke care settings. Oral care could be improved by increasing training, performing individual assessments on admission, and using standardised assessment tools and protocols to guide high quality care. The study highlights the need for incorporating staff training and the use of oral care standardised assessments and protocols in stroke care in order to improve patient outcomes

Trait emotional intelligence and attentional bias for positive emotion: An eye tracking study

Emotional intelligence (EI) may promote wellbeing through facilitation of adaptive attentional processing patterns. In the current study, a total of 54 adults (43 females, mean age = 25 years, SD = 10 years) completed a Trait Emotional Intelligence (TEI) scale and took part in three eye-tracking tasks, where they viewed (1) faces with different emotions (happy, angry, fearful, neutral), (2) 16-face crowds with varying ratios of happy to angry faces, and (3) 4 visual scenes (physical threat, social threat, positive social, neutral). Findings showed that higher TEI was associated with more attention to positive emotional stimuli (happy faces, positive social scenes), relative to negative and neutral stimuli. An attentional preference for positive rather than negative emotional stimuli may be one way that TEI affords protection from stressors to promote mental health

Loneliness and attention to social threat in young adults: Findings from an eye tracker study

Cacioppo and Hawkley (2009) have hypothesized that lonely people are hyper-vigilant to social threat, with earlier work (Jones & Carver, 1991) linking this bias specifically to threats of social rejection or social exclusion. The current study examined this hypothesis in eighty-five young adults (mean age. = 18.22; SD. = 0.46; 17-19. years in age) using eye-tracking methodology, which entailed recording their visual attention to social rejecting information. We found a quadratic relation between the participants' loneliness, as assessed by the revised UCLA loneliness scale, and their visual attention to social threat immediately after presentation (2. s). In support of Cacioppo and Hawkley's (2009) hypothesis, it was found that young adults in the upper quartile range of loneliness exhibited visual vigilance of socially threatening stimuli compared to other participants. There was no relation between loneliness and visual attention to socially threatening stimuli across an extended subsequent period of time. Implications for intervention are considered. © 2014 Elsevier Ltd