Measurement of mothers' confidence to care for children assisted with tracheostomy technology in family homes.

The purpose of this research was to develop an objective, linear measure of mothers' confidence to care for children assisted with tracheostomy medical technology in their homes. Caregiver confidence is addressed in this research for three technologies, namely, a) trachesotomy, b) tracheostomy and ventilator, and c) BiPAP/CPAP although detailed measurement results are only reported for tracheostomy, and its co-calibration with tracheostomy and ventilator caregiving items. The sample consisted of 53 mothers responding to several caregiver questionnaires based on a caregiving task matrix after content and clinical validation. A major challenge was integrating this construct with overarching principles already established by Functional Caregiving, a multi-level humanistic caregiving model for children with intellectual disabilities. Empirical analyses included principal components analysis, and then linear transformation of Tracheostomy item ratings to an objective, equal-interval scale with a Rasch model. Results show caregiver separation on the Tracheostomy caregiving scale was 2.66 and reliability, .88. In general, co-calibration improved measurement properties without affecting mothers' caregiving confidence measures. Although sample size was small, measuring mothers' confidence to care for a child supported by complex medical technologies appears very promising.

Nonequivalent survey consolidation: an example from functional caregiving.

Functional Caregiving (FC) is a construct about mothers caring for children (both old and young) with intellectual disabilities, which is operationally defined by two nonequivalent survey forms, urban and suburban, respectively. The purposes of this research are, first, to generalize school-based achievement test principles to survey methods by equating two nonequivalent survey forms. A second purpose is to expand FC foundations by a) establishing linear measurement properties for new caregiving items, b) replicate a hierarchical item structure across an urban, school-based population, c) consolidate survey forms to establish a calibrated item bank, and d) collect more external construct validity data. Results supported invariant item parameters of a fixed item form (96 items) for two urban samples (N = 186). FC measures also showed expected construct relationships with age, mental depression, and health status. However, only five common items between urban and suburban forms were statistically stable because suburban mothers' age and child's age appear to interact with medical information and social activities.

Injuries associated with teacher assaults: magnitude, nature, cost, and outcome.

The purpose of this retrospective study was to describe the magnitude, nature, and costs of assault injuries among teachers, a high-risk group. Review of assault cases (N = 341) was based on internal and case management vendor records. The 3-year assault rate was 3.24 per 1,000 teachers. Assaults were predominately physical, occurring during classroom disputes and while restraining students. Assaults accounted for 2,480 lost workdays and more than dollars 714,000 in lost wages and case management fees. The most costly injuries on a per-case basis were strain-sprain injuries resulting in lost workdays and fractures not resulting in lost workdays. Less than 20% of the assaults accounted for all of the lost workdays and most of the case costs. Study variables accounted for 13% of case costs. Occupational health nurses should collaborate with school personnel, administrators, and parents to develop prevention programs, which may include de-escalation techniques for teachers as well as case management strategies.

Rasch analysis of a new construct: functional caregiving for adult children with intellectual disabilities.

This research examined empirical evidence for a new construct, Functional Caregiving, which is a theory about mothers' caregiving of their adult children with intellectual disabilities. A sample of 108 biological mothers and primary caregivers rated survey items about their confidence to perform caregiving tasks. Rasch rating scale analysis found 61 items defined an empirical construct with three caregiving levels: Advocacy, Personal Caregiving, and Community. Results show item separation was 3.11 with high reliability, .91, and mother separation was 2.93 and reliability, .90. Both items and mothers showed adequate INFIT and OUTFIT values. Item invariance was confirmed between older and younger mothers, and principle components analysis of item residuals did not reveal any major dimensionality threats. Item decomposition analysis showed FC content theory to account for 58 percent of item calibration variance (R2 = .58, F = 42.3, p < .001). These results have important practical implications for health and social services, as well as family caregiving, interdisciplinary practices, and health policy development.

Nursing care quality: process and outcome relationships.

The relationships between variables in a proposed model for the quality of nursing care provided in the home were examined using a cross-sectional correlational design. Sixty patients discharged from a home-care agency were interviewed in their homes using instruments to measure the model's 7 variables. It was proposed that nursing care provided is related to 3 aspects of the interpersonal process--affective support, health information adequacy, and decisional control--and that these 3 variables are related to 3 outcomes--adherence, symptoms, and well-being. The findings support relationships between technical and interpersonal process components. Significant relationships were found between health information adequacy and adherence and between decisional control and well-being. The authors conclude that further refinement of the model will help to build a stronger foundation for the study and provision of quality nursing care.

Development of an instrument measuring family care.

This study developed and evaluated an instrument to measure the quality of care given by family members to a patient in the home. The Family Care Measure consisted of 11 items, each of which was rated on a visual analogue scale. Fifteen registered nurses rated the care given by families of 72 eligible patients for whom the nurses had provided nursing care. Estimation of the reliability resulted in a high internal consistency. With deletion of five items from the measure, the internal consistency reliability resulted in a Cronbach's alpha coefficient of .93. The six-item instrument correlated moderately, as predicted, with a scale of family coping (r = .76). With acceptable reliability and evidence of construct validity, this measure may be used in research studies, but further testing to assess its usefulness in clinical situations is recommended.

Health promotion behaviors in Chinese family caregivers of patients with stroke.

The purpose of this study was to explore the relationship between and among the caregiver's personal factors, the care recipient's functional status, the caregiver's perceived self-efficacy, social support, reactions to caregiving, and health promotion behaviors in family caregivers of community-dwelling stroke patients in Taiwan. A structured home-interview survey methodology was used to collect data from 134 primary caregivers responsible for care of stroke patients in Taipei, Taiwan. The study results indicated that, in general, caregivers were female spousal caregivers (mean age 52 years, average caregiving period 24 months). Regression analyses revealed that the caregiver's health status was the strongest positive predictor of caregiver self-efficacy. Spousal caregivers with a better-perceived health status were more satisfied with their resources of social supports. Spousal caregivers with poor perceived health status had a higher level of caregiving strain. Results for the overall model indicated caregiver's social support and the care recipient's functional status made significant contributions in explaining the caregiver's health promotion behaviors. Implications for further practice suggest establishing community training programs and support groups for family caregivers.

Weight loss and weight loss maintenance in African-American women.

The purpose of this study was to identify factors associated with weight loss and weight loss maintenance in 23 African American women participating in a 32-week lifestyle enhancement awareness program (LEAP), 16 weekly sessions on weight loss and 16 weekly sessions on weight loss maintenance. A pre-test, post-test one group design was used. Measures included dietary readiness to lose weight, bioelectrical impedance analysis, lipid levels, blood pressure, waist/hip ratio, weight, height, and activity level. Women who completed the weight loss phase of the program showed a reduction in weight; body mass index; percentage body fat; and waist/hip ratio; and an increase in physical activity and dietary readiness to control over-eating. Weight loss was significantly correlated with attendance and dietary readiness to decrease emotional eating. Women who continued on to complete the weight loss maintenance classes maintained a significant loss in body mass index, and increased their high-density lipoproteins and dietary readiness to monitor hunger and eating cues. African-American women who sustain weight loss and weight loss maintenance regimens reduce their risks for developing chronic diseases.