Self-Transcendence in the Context of

Harmful Alcohol Use and HIV

1

Song Ge, BSN, RN, PhD student

HIV

HIV is a life-long disease, affecting over 1.2 million people

in the United States and almost 14% are unaware of their

infection status

Sources are found in main article: Wikipedia:Hiv#Acute_HIV infection 2

Alcohol Use

Harmful alcohol use is significantly more prevalent

among Immunodeficiency Virus (HIV) patients than the

general population

National Survey on Drug Use and Health (NSDUH) reported

that there were 136.9 million alcohol users aged 12 and above

in the US in 2013; 6.3% were classified as heavy drinkers.

In contrast, according to a study done by Galvan, 13% of the

HIV- positive population who received care in the US in

1996 were either or both drug dependent or heavy

drinkers (Galvan et al., 2014)

3

Galvan et al, 2014

Type of Harmful Alcohol Use

National Institute on Alcohol Abuse and Alcoholism

(NIAAA) defines Binge Drinking as a pattern of drinking

that brings blood alcohol concentration (BAC) levels

up to 0.08 g/dL. This typically occurs 2hrs after 4 drinks

for women and 5 drinks for men

Substance Abuse and Mental Health Services

Administration (SAMHSA) defines Heavy Drinking as

drinking 5 or more on once on at least 5 days in the

past 30 days.

4 http://www.stopdrinkingadvice.org/guide/index001.php

How Harmful Alcohol Use Affects HIV

Behavioral

+ Risky sex behaviors (Theall et al., 2007)

+ Sexually transmitted disease (Townsend et al., 2010)

+ HIV reinfection & transmission (Townsend et al., 2010)

+ Missing previous HIV test (Fetch et al. 2013)

+ Utilization of emergency department (Palepu et al., 2003)

+ Medical non-adherence (Neblett et al., 2011)

Biological

+ Interact with ART (Cooper et al., 2005)

+ Mortality (Bonacini et al., 2011)

+ Depression (Slot et al., 2015)

5

Current Interventions to Reduce Alcohol Use

6

Current evidence-based practice is based on self-

determination theory to develop brief intervention (BI) to reduce

alcohol use

David et al, 2005

My research interest

7

Whether interventions that improve self-

transcendence (such as meditation and guided

imaginary) would add to the effectiveness of brief

intervention on HIV-positive population

Self-Transcendence

The conceptual definition is, by Reed: “Inherent, gradual,

non-linear developmental process, resulting in increased

awareness of dimensions greater than the self and expansions of

personal boundaries within intrapersonal, interpersonal,

transpersonal and temporal domains” (McCarthy, Ling, Carini,

2013, p. 179).

8

Self-Transcendence

9

Facilitate the integration of complex and conflicting elements of living, aging and dying.

A character of developmental maturity, characterized by being more pragmatic, more spiritual, more tolerant of ambiguity.

The person who uses mature forms of reasoning does not seek absolute answers to questions but seek meaning of life in the moral, social and historical context.

Expressed self-transcendence can be sharing wisdom with others, accepting death as part of life, having an interest in helping others, letting go of losses and finding spiritual meaning of life.

Gulliver (2007) 10

Nursing Theory on Self-Transcendence

Self-Transcendence

Well-Being Vulnerability

Reed (1991)

Personal and

Contextual

Factors

Why nursing is important in understanding

self-transcendence?

Many of our patients face health-threatening events with increased risk of vulnerability and mortality and therefore are potential target for promoting healing and well-being through self-transcendence

Nurses care patients in a holistic manner. We care about their overall well being, not only their physiology health but the way they approach their life and illness and the way they view their environment

We want our patients to approach end of life with maturity

12 http://www.burnett.edu/practical_nursing.html

Current stage of use of the concept in the

context of HIV

Substantial research gaps exist in literature that

examines self-transcendence in the context of HIV (Mary

et al, 1997).

Most of the existing studies are qualitative studies

looking at the individuals’ self-transcendence experience.

13

Research Purpose

14

To examine how self-transcendence relates to

harmful alcohol consumption among HIV-positive

population who age 50+

Goal: to identify those HIV-positive population

who has high risk of harmful alcohol use and

deliver tailored self-transcendence related

intervention to them in addition to the traditional

brief interventions. to improve their well-being

Middle ranged theory on Self-Transcendence

Self-Transcendence

Well-Being Vulnerability

Reed (1991)

Personal and

Contextual

Factors

15

Nursing theory on Self-Transcendence

Self-Transcendence

Well-Being Vulnerability

Reed (1991) 16

Middle ranged theory on Self-Transcendence

Self-Transcendence

Well-Being Vulnerability

Reed (1991) 17

Nursing theory on Self-Transcendence

Self-Transcendence

Well-Being Vulnerability

Reed (1991) 18

Middle ranged theory on Self-Transcendence

Self-Transcendence

Well-Being Vulnerability

Reed (1991)

Personal and

Contextual

Factors

19

Self-Transcendence

Intrapersonal

Greater awareness of one’s own philosophy

Interpersonal

Relate to others and one’s environment

Temporal

Integrate one’s past and future in a meaningful way

Transpersonal

Connect with the dimension beyond

the discernible world

Self-

Transcendence

Scale (STS)

Continuous

20

Personal and Contextual Factors

Age

Demographic

Continuous

Gender

Demographic

Categorical

Cognitive ability

Mini Mental State Exam

Continuous

Significant life event

Demographic

Categorical

Personal beliefs

Survey of Personal Beliefs

Categorical

Family support

Multidimensio

nal Scale of

Perceived

Social Support

Continuous

Health status

General health

Medical record

categorical

Alcohol related health

AUDIT

Continuous

HIV-Specific health

Medical record

categorical

Reed, 1991 21

Well-being

Physical Psychosocial

Reed, 1991; Elsie, 1992

CD4

Count

Viral

Load BMI

Infectio

n

Medical

record

Continuous categorical

Life

satisfaction Positive self-

concept Self-

determination

Life

Satisfacti

on Score

Rosenberg

Self-Esteem

Scale AUDIT

C test

Continuous Continuous Continuous

22

Beck

Depressio

n

inventory

Low at risk

alcohol use

Vulnerability: Under Construction

23 Caring For The Vulnerable: Perspectives in Nursing Theory, Practice, and Research (De Chasnay, Caring for the Vulnerable)

Vulnerability is a

complex state not

easily quantifiable

Nutrition & environmental

health risk (water, food

security, air pollution)

disability, adequate

hoursing, threats to safety,

(criminal, substance abuse)

Social support, self-

esteem

Self-actualization

Study Design I: Quantitative Descriptive Study

24

Objective: To examine the association between self-

transcendence and alcohol consumption among HIV-

positive population aged 50 and above in Baltimore

Emancipatory: to emancipate the HIV-positive population

from the negative effects of alcohol

Outcome: Frequency, quantity and pattern of alcohol use

based on the outcome of AUDIT C (continuous)

Linear regression: regress self-transcendence on alcohol

use

ANCOVA: Does the association between alcohol use or

not and self-transcendence differ for different SES groups?

Study Design II: Quantitative Interventional study

25

Does nurse-led intervention on improving self-transcendence (meditation and guided imagery) improve the effectiveness of traditional brief intervention (BI) on alcohol reduction among HIV-positive population who age 50+ in Baltimore?

Post-positivism: one truth, we need to explore to get close to it.

Outcome: Frequency, quantity and pattern of alcohol use based on the outcome of AUDIT-C (continuous)

ANOVA: compare the change in alcohol use between two similar groups who had BI only and who had BI + meditation and guided imagery

Post-

screening Intervention

Pre-screening

Other theories that can be considered

26

Diathesis–Stress Model: A psychological theory that

explains behavior as a pre-dispositional vulnerability

together with stress from life experiences. This specific

model is in the context of HIV/AIDS

Trans theoretical Model

Pre-

contemplation

contemplation

Preparation

Action Maintenance

Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992

Questions?

27

Reference

28

Moroń M. Emotion understanding, interpersonal competencies and loneliness among students[J]. Polish

Psychological Bulletin, 2014, 45(2): 223-239.

Wilsnack and Wilsnack. 39. E. R. Shore, "Drinking Patterns and Problems among Women in Paid Employment,

Alcohol Health Research World 16 (1992)

Eugene K, Susan H, Juleint N, Saira N, Bikram P. Prevalence and risk factors of major depressive disorder in

HIV/AIDS as seen in semi-urban Entebbe district, Uganda. BMC Psychiatry. 2011; 11:205

Maslow's Hierarchy of Needs by Saul McLeod twitter icon published 2007

David Markland, Richard M. Ryan, Vanessa Jayne Tobin, Stephen Rollnick (2005). Motivational Interviewing and

Self–Determination Theory. Journal of Social and Clinical Psychology: Vol. 24, No. 6, pp. 811-831.

Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption

questions (AUDIT-C): an effective brief screening test for problem drinking. Archives of internal medicine, 158(16),

1789-1795.

De Chesnay, M. (Ed.). (2005). Caring for the vulnerable: Perspectives in nursing theory, practice, and research.

Jones & Bartlett Learning.

Emmons, K. (1996). “Commentary: The Transtheoretical model of behavior change: Application to clinical practice.”

Mind/Body Medicine 1: 221-223.

Galvan FH, Burnam MA, Bing EG. Co-occurring psychiatric symptoms and drug dependence or heavy drinking

among HIVpositive people.

Substance Use and Mental Health Estimates from the 2013 National Survey on Drug Use and Health-Overview of

Findings. The NSDUH Report, September 4, 2014

Appendix

29

30

31 http://www.integration.samhsa.gov/images/res/tool_auditc.pdf

Conceptual framework based on the Stress-

Diathesis Model on HIV/AIDs

Source: Prevalence and risk factors of major depressive disorder in HIV/AIDS as seen in semi-urban Entebbe district,

Uganda

Individuals Vulnerability

Socio-demographic factors

Gender(nominal)

Age(ratio)

Education(ordinal)

Employment(nominal)

Ethnicity(nominal)

Marital status(nominal)

Psychological&

social factors

Coping Psychiatry history Comorbid psychiatry

disorder Social support

Perceived social support

Social embededness

Social-ecological resources

Neurotoxic effects Adverse life events

Major depression disorder