The role of nurse-patient mutuality on self-care behaviours in patients with chronic illness.

AIM: To examine the role of nurse-patient mutuality on three self-care behaviours in chronic illness patients. DESIGN: A cross-sectional multi-centre study was conducted. METHODS: Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale which has the dimensions of developing and going beyond, being a point of reference and deciding and sharing care, and self-care was measured with the Self-care of Chronic Illness Inventory (SC-CII). Multivariable linear regression analyses were used to assess the contribution of three dimensions of mutuality on self-care maintenance, monitoring and management behaviours controlling for patient gender, age, education, number of medications, and presence of a family caregiver. RESULTS: The sample included 465 inpatients and outpatients with at least one chronic illness. The three dimensions of mutuality had different roles in their influence on the three dimensions of self-care. Developing and going beyond was significantly associated with self-care maintenance and self-care monitoring behaviours. Point of reference was significantly associated with self-care maintenance behaviour. Deciding and sharing care was significantly associated with self-care monitoring and self-care management behaviours. CONCLUSION: The mutuality between nurse and patient may be a novel area of research to support and improve patient self-care behaviours with implications for clinical practice and education. IMPLICATION FOR PROFESSION AND PATIENT CARE: Mutuality between nurse and patient increases patient engagement, symptom recognition, decision-making process and patient-centred approach favouring the development of self-care behaviours. IMPACT: Mutuality between nurse and patient is a new concept and its association with the patient outcomes could bring relevance to the nursing profession. Self-care behaviours are important in the management of chronic diseases, but are difficult to perform. Mutuality between nurse and patient influences the three different behaviours of self-care in chronic illness, for this reason it is important to increase the level of mutuality in this dyad. REPORTING METHOD: STROBE checklist for cross-sectional studies was followed in this study. PATIENT OR PUBLIC CONTRIBUTION: Patients were involved in the sample of the study.

Mutuality between nurses and patients with chronic illnesses: A cross-sectional descriptive study.

BACKGROUND AND AIM: Mutuality is a process in which the patient participates and is involved in decision-making and care interventions. The aim of this study was to measure mutuality in the relationship between nurses and chronic illness patients. METHODS: This study had a cross-sectional design; the sample included 249 patients and 249 nurses. Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale. RESULTS: Patients had higher scores in almost all items (p < 0.001). Patients demonstrate high reciprocity towards nurses and the ability to express and share their emotions. Patients consider nurses their point of reference and share with them their health goals. Nurses show more difficulty in being mutual with the patient, especially in the aspects related to the sharing of emotions, objectives, and planning. The egalitarian relationship score was low in both patients and nurses. CONCLUSION: These findings are important to consider at clinical, educational, organisational, and policy levels. Nurse education and organisation must push towards respect for the wishes of patients, the possibility of expressing their choices, and their involvement in the care plan. PRACTICE IMPLICATIONS: In clinical practice, it is necessary to put the patients more at the centre, involving them in the identification of objectives and in making decisions.

Predictors of rewarded caregiving for family caregivers of person with dementia: A longitudinal study.

The purpose of this study was to explore variables associated with rewarded caregiving for family caregivers of persons living with dementia over a 2-year follow-up. This correlational longitudinal study was comprised of 200 family caregivers of persons living with dementia from neurological clinics of a medical center was conducted. Dichotomous scoring of the Rewards of Caregiving Scale of the Family Caregiving Inventory resulted in 61 (30.5%) caregivers being assigned to the well-rewarded group and 139 (69.5%) to the poorly reward group at baseline. Variables included characteristics of family caregivers and their care receivers and assessments with validated scales of caregivers' social support and dyadic relational variables of mutuality, preparedness, and balance. Analysis at baseline showed significant predictors of well-rewarded family caregivers were being an adult child of the care receiver, having a high perceived level mutuality and having a high perceived level of preparedness. These three variables remained as significant predictors at the 1- and 2-year follow-up. Caregivers with high levels of perceived mutuality and preparedness at 2-years were seven times more likely to perceive themselves as well-rewarded. Based on the findings, developing clinical interventions that focus on promoting mutuality and preparedness for family caregivers of persons with dementia could allow caregivers to perceive their role as rewarding. Attention should also be paid to the relationship between the caregiver and care receiver to enhance the family caregiver's feelings of mutuality and preparedness.

Mutuality as a method: advancing a social paradigm for global mental health through mutual learning.

PURPOSE: Calls for "mutuality" in global mental health (GMH) aim to produce knowledge more equitably across epistemic and power differences. With funding, convening, and publishing power still concentrated in institutions in the global North, efforts to decolonize GMH emphasize the need for mutual learning instead of unidirectional knowledge transfers. This article reflects on mutuality as a concept and practice that engenders sustainable relations, conceptual innovation, and queries how epistemic power can be shared. METHODS: We draw on insights from an online mutual learning process over 8 months between 39 community-based and academic collaborators working in 24 countries. They came together to advance the shift towards a social paradigm in GMH. RESULTS: Our theorization of mutuality emphasizes that the processes and outcomes of knowledge production are inextricable. Mutual learning required an open-ended, iterative, and slower paced process that prioritized trust and remained responsive to all collaborators' needs and critiques. This resulted in a social paradigm that calls for GMH to (1) move from a deficit to a strength-based view of community mental health, (2) include local and experiential knowledge in scaling processes, (3) direct funding to community organizations, and (4) challenge concepts, such as trauma and resilience, through the lens of lived experience of communities in the global South. CONCLUSION: Under the current institutional arrangements in GMH, mutuality can only be imperfectly achieved. We present key ingredients of our partial success at mutual learning and conclude that challenging existing structural constraints is crucial to prevent a tokenistic use of the concept.

Caregiver burden, mutuality, and family resilience in colorectal cancer caring: A mediating model analysis.

PURPOSE: This study investigates the interaction between caregiver burden, mutuality, and family resilience in colorectal cancer management, and determines whether mutuality affects the effect of caregiver burden on family resilience. METHOD: In this cross-sectional study, 295 family caregivers of colorectal cancer patients from two major public hospitals (Henan Province, China) were analyzed. Caregiver burden, mutuality, and family resilience were assessed through Chinese versions of the Zarit Burden Interview (ZBI-C), the mutuality Scale (MS-C), and the Family Resilience Questionnaire (FaREQ-C). The structural equation model and multiple mediating effect test were applied to explore the interaction between caregiver burden, mutuality, and family resilience. RESULTS: Total and subscale scores of caregiver burden were negatively correlated with both mutuality (r = -0.54 to -0.32, P < 0.01) and family resilience (r = -0.60 to -0.26, P < 0.01). Family resilience and its four dimensions were positively correlated with mutuality (r = 0.17 to 0.51, P < 0.01). Mutuality served as a partial mediator between caregiver burden and family resilience. Caregiver burden had an indirect effect on family resilience through mutuality (ß = -0.157, 95%CI: -0.316, -0.046, P = 0.009). CONCLUSIONS: This study examined the interaction between caregiver burden, mutuality, and family resilience for colorectal cancer caring and confirmed the mediating role of mutuality in caregiver burden and family resilience. Therefore, we suggested that clinicians should develop strategies to improve the relationship between patients and caregivers so that both parties can actively manage stress and trauma experiences for improved colorectal cancer management.

Conceptualizing the peer contribution in Open Dialogue practice.

In English mental health services, people with their own experience of mental distress have trained as Open Dialogue practitioners and have been employed as peer practitioners, co-working as equals alongside workers with professional backgrounds in Network Meetings. The conceptual underpinnings of the peer practitioner role have been drawn from the principles and relational approach of Intentional Peer Support. These have significant similarities with Open Dialogue, in terms of philosophical and theoretical orientations, with a particular focus on what happens in the "between" of a relational encounter. However, there are also significant differences in how practice principles are conceptualized, particularly around areas such as mutuality and self-disclosure. This article offers an analysis of this conceptual territory drawing on the relevant literature. This is then taken forward with the teasing out of specific practice principles that capture the unique contribution that peer practitioners can bring to Open Dialogue practice. These are derived through discussions that took place in an Action Learning Set for peer practitioners who have been involved in delivering Open Dialogue services in mainstream mental health service settings. This was part of a wider research study entitled Open Dialogue: Development and Evaluation of a Social Network Intervention for Severe Mental Illness (ODDESSI). The principles address how peer practitioners may be particularly well-placed to offer attunement, validation, connection and mutuality, and self-disclosure - and hence how they may be able to contribute an additional dimension to dialogical practice.

Mutuality in nurse-caregiver relationships in pediatric nursing: A concept analysis.

PROBLEM: Mutuality is often used in literature in the context of family-centered care and therapeutic relationship building. A therapeutic relationship is necessary to deliver family-centered care, strengthen family health and function, increase patient and family satisfaction, reduce anxiety, and empower decision-makers. Despite mutuality being such an important concept, it is not well defined in the literature. ELIGIBILITY CRITERIA: The Walker and Avant method for concept analysis was used. The databases Medline, PSYCHInfo, CINHAL and Nursing & Allied Health were searched for texts in English from 1997 to 2021 using specific search terms. SAMPLE: Of the 248 results, 191 articles were screened and 48 met inclusion criteria. RESULTS: Mutuality was found to be a process of dynamic reciprocity whereby the partners contribute uniquely to their shared goals, values, or purposes. CONCLUSION: Mutuality is an important aspect of family-centered care and is used throughout nursing and advanced nursing practice. IMPLICATIONS: The concept of mutuality should be incorporated into family-centered care policies, as without it, family-centered care cannot be established. Further research should be done to develop methods or educational techniques to establish and maintain mutuality in advanced nursing practice.

The perceived relationship quality with migrant domestic workers is correlated with a lower level of loneliness among community-dwelling older adults: A cross-sectional study.

PURPOSE: To explore older adults' perceived relationship quality with migrant domestic workers (MDWs) and examine the correlation between older adult/MDW (O-M) relationship quality and loneliness of community-dwelling older adults. MATERIALS AND METHODS: In this cross-sectional study, older adults living with MDWs were conveniently recruited from neighbourhood elderly centers in Hong Kong. Loneliness and O-M relationship quality were assessed by the 6-item De Jong Gierveld Loneliness Scale and the mutuality scale, respectively. Older adults' demographic and functional characteristics, and MDW's nationality, spoken language and years of service in the dyad were also collected. Hierarchical multiple regression analyses were conducted to examine the contributions of 1) demographic variables and functional status, 2) MDW characteristics, 3) perceived social network and 4) perceived O-M relationship quality on loneliness. RESULTS: The 178 participants [mean age 83.44 (SD 7.05 years); 155 (87.1%) women and 23 men (22.9%)] were socially lonely (1.07 ± 1.15) and close to being lonely overall (1.90 ± 1.68), and emotionally (0.84 ± 0.97). The mean O-M relationship quality was poor (1.42 ± 0.79), which was significantly correlated with overall (ß= -0.33, 95% CI: -0.65 to -0.01, P value = 0.045), and social (ß= -0.24, 95% CI: -0.46 to -0.01, P value = 0.04) loneliness, but not significantly correlated to emotional loneliness. CONCLUSION: Better perceived O-M relationship quality is correlated with a lower level of loneliness among older adults. Strategies to improve O-M relationship quality may alleviate loneliness among older adults.

Development and validation of two versions of the Nurse-Patient Mutuality in Chronic Illness scale.

AIMS: The aim of the study was to develop and psychometrically test the Nurse-Patient Mutuality in Chronic Illness (NPM-CI) scale in two versions, one for nurses and one for patients. METHOD: A multiphase methodological study was conducted. In the first phase, a qualitative investigation was conducted through interviews and an analysis of the content; inductively, the items of two instruments were generated, one for nurses and one for patients. In the second phase, the content and face validity were assessed through the expert consensus method. In the third phase, exploratory factor analysis (EFA), Cronbach's alpha test, intraclass correlation and Pearson correlation coefficients were conducted to estimate construct, criterion validity and instrument reliability. For each phase, the sample included nurses and patients recruited from a large hospital in Northern Italy. Data collection was conducted between June and September 2021. RESULTS: Nurse and patient versions of the NPM-CI scale were developed. Two rounds of consensus reduced the items from 39 to 20; content validity index ranged between 0.78 and 1, content validity ratio was 0.94. Face validity indicated clarity and comprehensibility of the items. EFA identified three latent factors for both the scales. Internal consistency was satisfactory, with Cronbach's alphas ranging between .80 and .90. Test-retest stability was suggested, with an intraclass correlation coefficient of .96 (nurse scale) and .97 (patient scale). Predictive validity was established, with a Pearson correlation coefficient of .43 (nurse scale) and 0.55 (patient scale) between the mutuality scales and satisfaction in providing and receiving care. CONCLUSION: The results suggest that the NPM-CI scales are sufficiently valid and reliable for the clinical practice among chronic illness patients and the nurses caring for them. A more in-depth exploration of this construct in the context of nursing and patient outcomes is warranted. PATIENT OR PUBLIC CONTRIBUTION: Patients were involved in all study phases. IMPACT: Mutuality is fundamental in the relationship between nurse and patient, based on trust, equality, reciprocity, and mutual respect. The NPM-CI scale was developed and psychometric estimated through a multiphase study in both nurse and patient versions. The NPM-CI scale measures the factors of 'developing and going beyond', 'being the point of reference' and 'deciding and sharing care'. The NPM-CI scale allows us to measure mutuality in clinical practice and research. Expected outcomes and influencing factors for patients and nurses could be associated.

Intercambios entre la educación y la teoría de las representaciones sociales en Brasil / Intercâmbios entre Educação e Teoria das Representações Sociais no Brasil / Exchanges between Education and the Thor of Social Representations in Brazil

En este artículo nos proponemos ofrecer una perspectiva alternativa a las que orientan los análisis acerca de las relaciones entre la Educación y la Teoría de las Representaciones Sociales. En oposición a la tradición que considera la Educación como un campo de aplicación de la psicología, defendemos que entre ambas esferas del conocimiento hay contribuciones mutuas. A mutualidad se entiende al proceso de interacción recíproco, a la interdependencía y a la cooperación, a la solidaridad y ayuda mutua. La mutualidad de la Educación y la Teoría de las Representaciones Sociales consiste en el movimiento que estimula estudios en el contexto brasileño, sobre todo los que se han desarrollado en el Centro Internacional de Estudos em Representações Sociais e Subjetividade ­ Educação (CIERS-ed). Los análisis realizados acerca de las contribuciones de la Teoría de las Representaciones Sociales a la Educación ponen de manifiesto el incremento de investigaciones que consideran la producción de saberes basados en realidades sociales contextualizadas, así como la importancia que tiene la subjetividad de educadores y educandos. A su vez, la Educación viene ofreciendo a las investigaciones en representaciones sociales un avance que va desde el diagnóstico hasta la praxis, pautado sobre todo por abordajes críticos y políticos del pensamiento educacional. (AU)

Neste artigo propomos oferecer uma perspectiva alternativa àquelas que orientam a análise da relação entre a Educação e a Teoria das Representações Sociais. Em oposição à tradição que considera a Educação como um campo de aplicação da psicologia, argumentamos que existem contribuições mútuas entre as duas esferas do conhecimento. A reciprocidade é entendida como o processo de interação recíproca, interdependência e cooperação, solidariedade e ajuda mútua. A mutualidade entre a Educação e a Teoria das Representações Sociais consiste no movimento que estimula os estudos no contexto brasileiro, especialmente os que foram desenvolvidos no Centro Internacional de Estudos em Representações Sociais e Subjetividade - Educação (CIERS-ed). As análises realizadas sobre as contribuições da Teoria das Representações Sociais à Educação destacam o aumento das pesquisas que consideram a produção de conhecimento a partir de realidades sociais contextualizadas, bem como a importância da subjetividade dos educadores e aprendizes. Ao mesmo tempo, a Educação vem oferecendo às pesquisas sobre representações sociais um progresso que vai do diagnóstico à práxis, guiado principalmente por abordagens críticas e políticas do pensamento educacional. (AU)

In this paper, we propose to offer an alternative perspective to those that guide the analysis of the relationship between Education and the Theory of Social Representations. In opposition to the tradition that considers Education as a field of application of psychology, we argue that there are mutual contributions between both spheres of knowledge. Mutuality is understood as the process of reciprocal interaction, interdependence and cooperation, solidarity, and mutual help. The mutuality of Education and the Theory of Social Representations consists in the movement that stimulates studies in the Brazilian context, especially those that have been developed at the Centro Internacional de Estudos em Representações Sociais e Subjetividade - Educação (CIERS-ed). The analyses carried out on the contributions of the Theory of Social Representations to Education highlight the increase in research that considers the production of knowledge based on contextualized social realities, as well as the importance of the subjectivity of educators and learners. At the same time, Education has been offering research on social representations progress that goes from diagnosis to praxis, mainly guided by critical and political approaches to educational thought. (AU)

Chinese adolescents' depression, anxiety, and family mutuality before and after COVID-19 lockdowns: Longitudinal cross-lagged relations.

Objective: This study aimed to investigate the longitudinal cross-lagged association between family mutuality, depression, and anxiety among Chinese adolescents before and after the COVID-19 lockdown in 2020. Background: Limited attention has been paid to the longitudinal links between family mutuality, depression, and anxiety in the context of the COVID-19 pandemic. Method: We used self-administered questionnaires to collect data from three high schools and two middle schools in Chengdu City at two time points: Time 1 (T1), December 23, 2019-January 13, 2020; Time 2 (T2), June 16-July 8, 2020. The sample consisted of 7,958 participants who completed two wave surveys before and after the COVID-19 lockdown. We analyzed the data using cross-lagged structural equation modeling. Results: The longitudinal cross-lagged model showed family mutuality at T1 significantly predicted depression, anxiety, and family mutuality at T2. We observed a decreasing prevalence of depression and anxiety after the COVID-19 lockdown. Conclusion: Family mutuality plays an important role in mitigating long-term mental health disorders, such as depression and anxiety. More family-centered psychological interventions could be developed to alleviate mental health disorders during lockdowns. Implications: Improving family mutuality (e.g., mutual support, interaction, and caring among family members) could be beneficial for reducing mental health disorders among Chinese adolescents during the COVID-19 pandemic.

Improving distress perception and mutuality in migraine caregivers after 6 months of galcanezumab treatment.

OBJECTIVE: This prospective cohort, real-life study aimed to evaluate whether galcanezumab, a monoclonal antibody anti-calcitonin gene-related peptide (CGRP) ligand, can reduce caregivers' distress and improve their mutuality with patients. BACKGROUND: Migraine is a highly disabling chronic disease that negatively impacts patients' and often their relatives' lives, occurring during an active phase of life with direct consequences on leisure- and work-related activities. The figure of caregiver is crucial in several neurological conditions but poorly accounted for in migraine care so far. Studies on monoclonal antibodies against the CGRP pathway, recently introduced as migraine-preventive treatments, demonstrated that they significantly reduce migraine frequency and disability in the first weeks of treatment. METHODS: Consecutive patient-caregiver dyads were evaluated at baseline and after 6 months of treatment with galcanezumab (V6) at our headache center from September 2020 to September 2021. Enrolled patients were requested to report their monthly migraine days, monthly intake of acute medications, attack pain intensity (on the Numeric Rating Scale), concomitant preventives, and disability questionnaires (Headache Impact Test, Migraine Disability Assessment). Each dyad filled in the Mutuality Scale to check their reciprocity; moreover, the Relatives' Stress Scale was used to detect caregivers' distress. RESULTS: We enrolled 27 patient-caregiver dyads. At 6 months, migraine burden significantly improved with reductions in monthly migraine days (falling from 14.8 [SD = 4.8] days by 10.3 [SD = 4.8] days; 95% CI: 8.4, 12.2; p < 0.001) and Migraine Disability Assessment scores (lowering from 83.6 [SD = 46.7] by 71.5 points [SD = 49.3]; 95% CI: 51.2, 91.9; p < 0.001). From baseline to month 6, the caregiver Relatives' Stress Scale score significantly decreased (falling from 20.7 [SD = 13.7] by 6.5 [SD = 14.1] points; 95% CI: 0.8, 12.2; p = 0.027), while the Mutuality Scale's caregiver total score increased (from 3.04 [SD = 0.61] by 0.29 [SD = 0.49] points; 95% CI: -0.508, -0.064; p = 0.014). CONCLUSIONS: Our findings preliminarily demonstrated that patients' migraine improvement after 6 months of galcanezumab treatment could be favorably perceived by caregivers, significantly reducing their distress with better reciprocity within the dyad.

Relationship between mutuality and depression in patients with chronic heart failure and caregivers in China: An actor-partner interdependence model analysis.

Background: Patients with chronic heart failure and their family caregivers may experience adverse emotional problems, such as depression. Mutuality, which refers to the relationship between caregivers and those they care for, is an important factor affecting depression in the dyads. The purpose of this study was to investigate the relationship between mutuality and depression in patients with CHF and their caregivers in China. Methods: In this cross-sectional study, we used the Mutuality Scale and the Self-Rating Depression Scale to measure mutuality and depression of patients and caregivers. We used SPSS version 26.0 and AMOS version 21.0 to analyze the data. An APIM was established to analyze the actor-partner effects of patient-caregiver mutuality and depression. Results: A total of 250 dyads of patients and caregivers were included in the study. There were statistically significant differences in mutuality and depression between CHF patients and caregivers. The 4 dimensions of patients' mutuality all have the actor effect on depression. There were 3 partner effects of caregivers' "pleasurable activities", "shared values", and "reciprocity" on depression. Regarding caregiver depression, we only found an actor effect of caregivers' "shared values" on depression. Conclusion: The relationship between patients and caregivers should be evaluated in the clinical setting, and it is very important to develop intervention measures to improve the adverse emotional problems affecting both patients and their caregivers.

Peer contagion dynamics in the friendships of children with ADHD.

BACKGROUND: Friendships in middle childhood carry high developmental significance. The majority of children with attention-deficit/hyperactivity disorder (ADHD) have few friendships, unstable friendships, or poor relationship quality in any friendships they have. The current study used time-window sequential analysis to map the dynamics within the friendships of children with ADHD, specifically the peer contagion processes of dyadic mutuality and coercive joining. METHODS: Participants were 164 dyads consisting of a target child with ADHD and peer problems (age 6-11 years; 68% male; and 73% white) and a reciprocated friend. Dyads were observed in the lab during a cooperative task eliciting verbal negotiation processes to decide how to share a limited resource and during a fast-paced, engrossing, and competitive task. Both tasks were designed to mirror the real-world interactions of friends. Sequences of dyadic mutuality (i.e., reciprocity of positive affect and positive behaviors) and coercive joining (i.e., reciprocity of aggressive, controlling, and rule-breaking behaviors) between target children and friends were coded. RESULTS: Regarding dyadic mutuality, target children reciprocated their friends' positive affect in both tasks. They also reciprocated their friends' positive behaviors but only in the cooperative task. In contrast, they only reciprocated their friends' coercive joining behaviors in the competitive task. Medium to large reciprocity effects was found for 36%-53% (dyadic mutuality) and 38%-55% (coercive joining) of target children. CONCLUSIONS: These results extend findings of peer contagion processes to the friendships of children with ADHD and suggest that contagion may vary according to interaction context (i.e., competition vs. cooperation). Understanding the spread of peer contagion may illuminate how children with ADHD and their friends influence each other's adjustment over time and may guide friendship-focused psychosocial interventions for this population.

The relationship between mutuality and contributions to self-care in family caregivers of patients with heart failure: multiple mediating effects of resilience and self-efficacy.

AIMS: Previous studies have indicated a positive association between mutuality and caregiver contributions to heart failure self-care (CC-HFSC). However, little is known about the underlying mechanisms in the relationship. This study aimed to determine whether resilience and self-efficacy play multiple mediating roles in the association between mutuality and CC-HFSC. METHODS AND RESULTS: In this cross-sectional, correlational study, a self-reported survey was conducted in 259 patient-caregiver dyads recruited from two hospitals in China using a convenience sampling method. Better mutuality (r = 0.27, P < 0.01), resilience (r = 0.23, P < 0.01), and self-efficacy (r = 0.34, P < 0.01) were correlated with greater CC-HFSC maintenance. Better mutuality (r = 0.29, P < 0.01), resilience (r = 0.20, P < 0.01), and self-efficacy (r = 0.35, P < 0.01) were correlated with greater CC-HFSC management. In multiple mediation models, self-efficacy independently [effect = 0.061, 95% confidence interval (CI) (0.024-0.119)] and resilience and self-efficacy serially [effect = 0.017, 95% CI (0.007-0.036)] mediated the association between mutuality and CC-HFSC maintenance. Meanwhile, self-efficacy independently [effect = 0.058, 95% CI (0.020-0.113)] and resilience and self-efficacy serially [effect = 0.018, 95% CI (0.007-0.038)] mediated the association between mutuality and CC-HFSC management. CONCLUSIONS: Resilience and self-efficacy were multiple mediators in the association between mutuality and CC-HFSC. Interventions targeting the facilitation of mutuality, and then increasing resilience and self-efficacy may be beneficial for improving CC-HFSC.

Mutuality in nursing: A conceptual framework on the relationship between patient and nurse.

AIMS: To describe and develop a conceptual framework for the process of mutuality between nurse and patient. DESIGN: This was a qualitative study with a grounded theory (GT) design following the constructivist approach of Charmaz (SAGE handbook of research, 2014). METHODS: A sample of 33 patients with one or more chronic diseases and 35 nurses were interviewed between July and October 2020. Comparative and simultaneous data analyses were conducted. Theoretical sampling and saturation of categories were used to define the sample size. RESULTS: A conceptual framework for mutuality between nurse (mean age 42 SD ±7 years, 89% female) and patient (mean age 63 SD ±8 years, 42% female) was developed, including the mutuality process, potential influencing factors for both nurses and patients, and outcomes. The mutuality process was characterised by three dimensions: developing and going beyond, being a reference, and deciding and sharing care. Influencing factors for nurses were personal characteristics and professional organisation, while for patients these were age and past experiences. Nurse outcomes were satisfaction and quality of life; patient outcomes were improved self-care and reduction of hospitalisation and emergency admissions. CONCLUSION: This study described a new conceptual framework for mutuality between nurse and patient, which could improve our understanding of the relationship between nurses and patients, thus enhancing both nurse and patient outcomes.

Psychiatric morbidity and its correlates among primary family caregivers of individuals diagnosed with schizophrenia in Taiwan.

BACKGROUND: Caregiving for patients with schizophrenia is often challenging and may increase the risk of psychiatric morbidity among primary family caregivers. However, the associated factors of psychiatric morbidity among caregivers have not been fully investigated. AIMS: This study aimed to screen psychiatric morbidity and its correlates among primary family caregivers of persons with schizophrenia receiving inpatient psychiatric rehabilitation services. METHODS: A cross-sectional, correlational design was used. A total of 184 Taiwanese primary family caregivers in inpatient psychiatric rehabilitation units participated in the study. Descriptive statistics, Chi-square tests, independent t-tests, and a stepwise binary logistic regression analysis were performed to examine the association among primary family caregivers' psychiatric morbidity and primary family caregivers' sociodemographic characteristics and mutuality and patients' sociodemographic and clinical characteristics. RESULTS: The prevalence of psychiatric morbidity among primary family caregivers was 48.4%. Unemployment, lower mutuality, additional dependents in need of care, and caring for patients with more psychiatric hospitalizations were the most significant factors for psychiatric morbidity among primary family caregivers. CONCLUSION: Mental healthcare professionals should recognize patients and their primary family caregivers as a unit of care. Primary family caregivers must receive increased assistance, including supportive resources and therapeutic interventions, to reduce psychiatric morbidity.

Cultivating mutuality: A qualitative study of community end-of-life care in Hong Kong.

In Hong Kong, death and dying are identified as a crucial public health issue, and as the healthcare system has developed, there has been a shift of some care for dying people and their families to cross-disciplinary collaboration in community settings. This shift enhances the salience of social relationships in non-medical forms of community-based end-of-life (EOL) care. The purpose of this paper is to contribute to knowledge about relational development in this regard. Abductive grounded theory methodology was used to examine the complex dynamics and mechanisms involved in cultivating mutuality between dying people (and their families) and volunteers and professionals in two community-based EOL social service agencies in Hong Kong. Qualitative data were collected between June and December 2019 using in-depth interviews with 14 agency practitioners and two theoretically sampled service users. Theoretical coding followed open coding to reach theoretical saturation. Cultivating mutuality was found to entail processes of finding social commonalities (and hiding differences), immersing in routines, supporting actualisation (granting the wishes of dying persons and their families) and engaging with clients' emotions (encouraging emotional release, demonstrating emotional involvement and actively listening). Findings offered a novel symbolic interactive and relational understanding of community EOL care practice. Contributions include theorising social processes in an intermediate stage of social capital and compassionate community development.

Influence of mutuality on quality of life in heart failure patient with inadequate self-care and caregiver dyads: an actor-partner interdependence model analysis.

AIMS: Mutuality, a positive quality of the relationship between patients and their informal caregivers characterized by love and affection, shared pleasurable activities, shared values, and reciprocity, influences several patient-caregiver outcomes in chronic-condition cases, but it remains unknown whether it influences the heart failure (HF) patient-caregiver dyad quality of life (QOL). The aim of this study was to evaluate the influence of mutuality and its four dimensions (love and affection, shared pleasurable activities, shared values, and reciprocity) on QOL in HF patient-caregiver dyads. METHODS AND RESULTS: Cross-sectional study: Using the actor-partner interdependence model, we examined how an individual's mutuality influenced his/her own QOL (actor effect) and his/her partner's QOL (partner effect). Mutuality and physical and mental QOL were measured with the Mutuality Scale and Short Form 12, respectively. A total of 494 HF patient-caregiver dyads were enrolled in the study. Mutuality showed strong evidence of caregiver partner effects on the HF patients' physical QOL (total score B = 2.503, P = 0.001; shared pleasurable activities B = 2.265, P < 0.001; shared values B = 1.174, P = 0.420 and reciprocity B = 1.888, P = 0.001). For the mental QOL, mutuality and its four subscales had actor effects only on the patients' mental health (total mutuality B = 2.646, P = 0.003; love and affection B = 1.599, P = 0.360; shared pleasurable activities B = 2.599, P = 0.001; shared values B = 1.564, P = 0.001 and reciprocity B = 1.739, P = 0.020). In caregivers, mutuality had an actor effects on mental QOL (total score B = 1.548, P = 0.041 and reciprocity B = 1.526, P = 0.009). CONCLUSION: Our results confirm the important role of mutuality in determining the physical and mental QOL in HF patient-caregiver dyads. Interventions aimed at improving the relationships within HF patient-caregiver dyads may have an impact on HF patients' and caregivers' QOL.

Resilient cultural practices for cognitive development during childhood within learning pathways with support from mediated mutual reciprocal theory.

Introduction: This paper examines resilient cultural practices, informed by cultural values for cognitive development in socialisation during childhood within the learning pathways model. It argues that the active role of children in their learning is not well captured or explained by theories or even empirical data. Learning pathways as a model in this paper is significant because it orients thinking on the fact that all activities children engage in always have social, psychological, and physical implications for cognitive enrichment. The activities are driven by resilient cultural practices informed by cultural norms, beliefs, and values such as responsible leadership qualities and cultivating socio-emotional and moral balance. With the above reasoning, this paper is underpinned by an empirical study with six specific objectives supported by Mediated Mutual Reciprocity theory. Methods: The study used a mixed research design and conveniently selected a sample of 73 parents and teachers whose ages ranged from 25-50 years. A questionnaire and an interview guide were used for data collection. The three-sections questionnaire was constructed to find out information about resilient cultural practices and cognitive development. The items in sections two and three were rated on a 5 points Likert scale based on the occurrence of practices and behaviours. The interview guide was constructed to find out information on the three learning pathways; physical, social and psychological that are relevant to children in African cultures. Data were analysed using frequency and proportions and Multiple Regression Analysis to aggregate scores for given conceptual components. Analysis of qualitative data followed the systematic process of thematic and content analysis. Results: Based on qualitative findings, it was realised that African children are exposed to physical, social, and psychological pathways to learning. Quantitative results showed that 85.5% of respondents are high in their resilient cultural practices whereas 14.5% of them are low in resilient cultural practices. In the same line, 74.4% of respondents' cognitive development is high while a proportion of 25.6% is low. The inferential statistics showed that resilient cultural practices are significantly predictive of cognitive processes, reasoning, skills, and strategies at a 0.000 level of significance. Discussion: Based on the use of the principles of the Mediated Mutual Reciprocal Theory, the study affirms the importance of children's contributory role in their learning and cognitive development. The link between pathways, resilient cultural practices, and cognitive development highlights the significance of children's involvement in their development through participation.