Developing a context-based performance measure for persons with schizophrenia: the test of grocery shopping skills.

OBJECTIVE: This article describes how authenticity and directness, desired characteristics of performance measures, were applied to the development of a context-based Test of Grocery Shopping Skills (TOGSS) for persons with schizophrenia. METHOD: The steps used in developing the measure included interviewing consumers with schizophrenia to identify issues in grocery shopping, conceptualizing how authenticity and directness could be applied to shopping performance, and selecting grocery items to be used in the test. The two forms of the TOGSS were administered to 26 persons with schizophrenia or schizoaffective disorders to evaluate reliability (stability, equivalence, interrater) and validity (convergent, generalizability) of the TOGSS. RESULTS: The correlations between the two forms of the TOGSS over two different testing periods were significant, ranging from .64 to .83. Subscale scores were moderately correlated (R = .52 to .94) with a similarly constructed test of drugstore shopping. CONCLUSION: A systematic method can be used to develop a context measure of performance. The TOGSS has beginning evidence of reliability and validity. With further study, the test will be useful in assessing the independent living skill of grocery shopping in persons with psychiatric disorders.

Internal and external environment of individuals with schizophrenia during alcohol and drug use.

Explanations for the high prevalence of alcohol and drug abuse in schizophrenia purport that substance use is related to social-affiliative needs or to symptom regulation. Neither explanation was adequate in describing substance-use episodes in the present longitudinal study. The study involved repeated interviews of 10 individuals with schizophrenia about their internal and external environment during substance use. Qualitative analyses of interview responses showed variability in multiple versus single episodes in a day and categories labeled Activities Prior to Use and Social Context of Use. Individual subject's responses each had a unique pattern that characterized their substance-use episodes.

Validity of self-administered symptom scales in clients with schizophrenia and schizoaffective disorders.

Few studies have used self-administered symptom scales as outcome measures with individuals who have schizophrenia. However, with the increase in community-based treatment for the serious and persistently mentally ill and the emphasis on client empowerment, their ability to monitor and report symptoms needs to be assessed. Two forms of self-administered items, symptom distress statements and symptom intensity statements, were formed from 10 BPRS symptoms and administered to 29 individuals with schizophrenia. Both forms of self-administered items were highly correlated with BPRS items, supporting concurrent validity. Self-administered responses for positive symptoms of schizophrenia and nonpsychotic symptoms may be more valid than self-administered responses for negative or deficit symptoms.

The daily activities checklist:.

This paper introduces the Daily Activities Checklist (DAC), an assessment developed for use with individuals with severe mental illness living in the community. The DAC establishes a baseline of engagement in self-care and instrumental activities of daily living and involves the consumer in the data gathering process. Preliminary information related to the feasibility and reliability of the measure suggests individuals with severe mental illness can accurately complete the assessment. The DAC also discrimated between individuals with severe mental illness that were working and those that were not.

Alcohol, cannabis, nicotine, and caffeine use and symptom distress in schizophrenia.

The high prevalence of substance use, e.g., alcohol and illegal and nonprescribed drugs, in schizophrenia is widely recognized. One explanation for this high prevalence is that substance use may be a self-initiated method for managing symptoms. To test whether the intake of four substances--alcohol, cannabis, nicotine, and caffeine--would increase with increases in symptom distress, daily self-reports of symptom distress and substance intake over 12 weeks were analyzed with pooled time series analyses. Compliance with neuroleptic medication was added to the analyses to control for any changes in prescribed medication compliance while using nonprescribed drugs or alcohol. Of the four substances studied, only nicotine was significantly related to symptom distress. Higher distress with prodromal symptoms was related to decreases in nicotine use. Analysis of caffeine did not meet the criteria for significance but does provide direction for further research. Higher distress, with neurotic symptoms, was related to increases in caffeine use. Further research is needed to clarify the relationship between nicotine and symptoms.

Descriptions of wellness by individuals with schizophrenia.

A major challenge in the rehabilitation of individuals with schizophrenia is to establish a system of monitoring disease status so interventions can be instituted to prevent disease exacerbation and to promote healthier functioning. Monitoring illness status has primarily focused on indicators of illness. The aim of the present study was to determine what individuals with schizophrenia described as evidence of wellness to generate descriptors for a wellness questionnaire. Twenty participants diagnosed with schizophrenia and living in a community setting were interviewed about their descriptors of wellness. Coding of transcriptions of the interviews yielded two major categories of wellness: Statements related to the reduction or absence of troublesome (illness) indicators and statements related to the presence of helpful or positive (wellness) indicators. Three subcategories, thoughts, feelings, and actions or behaviors emerged under both major categories. The majority of wellness descriptions focused on the presence of wellness and were actions or behaviors.

Symptom monitoring in schizophrenia: potential for enhancing self-care.

In this study a symptom self-regulation model was used as a framework to examine the characteristics and stability of indicators of illness identified by individuals with schizophrenia. Subjects were interviewed to determine if they could identify indicators of illness and describe characteristics of their primary indicator. Primary indicators of illness from 51 subjects were categorized as anxiety-based, depressive, or psychotic. Subjects who identified psychotic indicators were more confident that their indicator occurred when they were getting ill than subjects with anxiety-based or depressive indicators, and subjects who identified psychotic and depressive indicators reported that their indicators were more troublesome than those identifying anxiety-based indicators. Anxiety-based indicators were reported by subjects to occur more frequently than indicators from the other two categories. Findings from a follow-up interview of 28 subjects 1 year later showed that approximately half reported either the same primary indicator of illness or identified an indicator in the same category (anxiety-based, depressive, or psychotic) as they had 1 year previously. The implications of the findings for enhancing self-care through monitoring symptoms are discussed.

Symptom beliefs and actual blood glucose in type II diabetes.

The relationships of blood glucose levels to symptoms and symptom beliefs were examined in this study of persons (N = 51) with Type II diabetes. Analyses revealed that 88% of the subjects had at least one symptom that was substantially correlated with blood glucose levels. However, subjects' symptom beliefs (symptoms subjects believe are the best indicators of high or low blood glucose levels) were largely unrelated to actual blood glucose levels. Thus, subjects were often mistaken about which of their symptoms were accurate indicators of blood glucose levels. Analyses also showed that the accuracy of symptom beliefs for low blood glucose was positively related to metabolic control.

Enhancing self-care in diabetes management using self-regulatory processes.

Findings from recent research on the self-regulatory process in Type II diabetes mellitus have clinical relevance for nurses and other diabetes educators. We analyzed a symptom self-regulation model and its relationship to demographic and therapeutic variables in persons with Type II diabetes mellitus. The model suggested that when such diabetic clients experienced disease-related symptoms, they used these symptoms as signals of abnormal blood glucose and took action to relieve these symptoms and improve their blood-glucose level. These actions were often judged by the investigators to have no immediate effect on blood-glucose level or, in some cases, to potentially worsen blood glucose. In this article, intervention strategies for nurses and other professionals engaged in diabetic education are developed to improve objective validation of symptom accuracy and to modify some perceptions held by the client with noninsulin-dependent diabetes and, in particular, those clients using oral agents.

Self-regulation in individuals with type II diabetes.

A model for self-regulation of diabetes was tested which proposed that individuals monitor their disease status by comparing their current state with their standard of well-being. When a discrepancy is experienced and associated with a change in blood glucose, action is taken to relieve the symptom and thereby regulate blood glucose. Two variables of the self-regulatory process (symptom-associating and action-taking) were tested through semi-structured interviews of 173 subjects who had Type II diabetes. Most (85%) subjects associated their symptoms with a change in blood glucose levels. Of subjects who associated symptoms with elevated blood glucose, 77% took action; of subjects who associated symptoms with lowered blood glucose, 89% took action. Only sex and insulin use were related to symptom associating and action taking. There was no relation between metabolic control measured by glycosylated hemoglobin and symptom association and action taking.

Use of symptoms by schizophrenics to monitor and regulate their illness.

Interviews with 62 outpatients with chronic schizophrenia and schizoaffective disorder indicated that many patients monitor symptoms that they associate with changes in their illness and alter their behavior based on their symptoms. Ninety-eight percent of the subjects identified symptoms, two-thirds of which were nonpsychotic, that indicated to them they were getting worse. Eighty-two percent of those who identified symptoms of decompensation responded by altering their behavior, either by self-treatment (such as self-medicating, engaging in a diversionary activity, or attempting to ignore the symptoms), by seeking mental health assistance, or both. The authors compare their findings with those of other studies and discuss the study's implications for research on and care of schizophrenic patients.

Illness experience in a chronic disease--ALS.

The representative case study method was used in a 1-year longitudinal study of two individuals with a chronic, degenerative, terminal neurological disease, ALS (amyotrophic lateral sclerosis, also known as Lou Gehrig's Disease). Participants were interviewed in their homes every 2 months to examine the effects of the illness on relationships with family, friends and the health care system. Changing ideas regarding causation, the use and evaluation of various therapies, use of illness role models, spiritual changes and symptom experience were also explored. Kleinman's concept of explanatory models guides the analysis of the data, although we argue for a greater emphasis on evaluation of therapies within this model.

Symptom use and self-regulation in type II diabetes.

A model of self-regulation that explains the health behavior of type II diabetic patients was tested by examining the use of symptoms as indicators of perceived blood glucose levels in 38 outpatients. Results of the study supported the self-regulation model by demonstrating that patients use symptoms to monitor blood glucose levels and to guide diabetes-related actions. Implications of the model for planning interventions with type II diabetes are discussed.

Patient-centered variables in primary and team nursing.

Patient-centered variables and their relationship to primary and team nursing have rarely been studied. In the present study the investigation focused on the following patient-centered variables: nurturance received, patient involvement, and frequency of nurse-patient contacts. Baseline observational data were collected on 12 adult medical patients experiencing team nursing care. A primary nursing care approach was then implemented on the same nursing unit, and 6 months later 12 patients were observed under this system. Patients were directly observed 24 hours a day for 5 days of hospitalization and audiotaped, using a specimen record method. This method produced transcripts that were coded for nurturance, involvement, and nurse-patient contacts. Results of the study showed that there were no differences between primary and team nursing care groups in the number of contacts, nurturance, or patient involvement with all nursing personnel or with professional nurses. However, when the primary group was adjusted to include only those patients for whom primary nursing care was fully implemented, the primary group received more nurturance (p less than .05) and had a tendency to be more active involved than did the team group (p less than .10). These findings indicate that the institution of primary nursing care is related to increased quality of nursing care.