The multidimensionality of caring: a confirmatory factor analysis of the Caring Nurse-Patient Interaction Short Scale.

AIM: This paper is a report of a study to evaluate the construct validity of the four-dimensional Caring Nurse-Patient Interaction-Short Scale using confirmatory factor analysis. BACKGROUND: Validating theoretical structures of caring is an ongoing challenge in the discipline of nursing. Our previous work has contributed to this literature by the exploration of the dimensionality of the Caring Nurse-Patient Interaction Short Scale via an exploratory factor analysis. The Caring Nurse-Patient Interaction Short Scale comprises 23 items reflecting four caring domains: humanistic care, relational care, clinical care and comforting care. METHOD: A methodological study was conducted involving a convenience sample of 531 nursing students in a baccalaureate nursing programme (20% were already Registered Nurses). Data were collected in 2002 and 2004. Confirmatory factor analysis of the Caring Nurse-Patient Interaction Short Scale was performed. FINDINGS: As expected with large samples and models, the chi-squared-associated P-value was statistically significant (chi2 = 811.43, d.f. = 224, P < 0.01). However, the other indices reached acceptable levels with 0.054 for the standardized root mean-squared residuals, 0.070 for the root mean-square error of approximation, 0.88 for the goodness of fit index, 0.98 for the comparative fit index and 0.97 for the normal fit index. The factor loadings for all items with their hypothesized factor were > or = 0.48 and statistically significant at the 0.01 level. CONCLUSION: The Caring Nurse-Patient Interaction Short Scale model was judged to fit the data adequately. Although further testing of the scale with different samples of patients is warranted, our model emerged as a middle-range theory during the construct validity process and still reflects Watson's theory while offering a structure that is testable in clinical research.

A dimensional structure of nurse-patient interactions from a caring perspective: refinement of the Caring Nurse-Patient Interaction Scale (CNPI-Short Scale).

AIM: This paper reports the development of a short version of the Caring Nurse-Patient Interaction Scale. BACKGROUND: Since the 1980s several instruments have been developed to assess external aspects of caring. They involve using an inductive process of knowledge development to investigate the underlying structure of caring, and few reflect an explicit underlying caring theory. We developed the Caring Nurse-Patient Interactions Scale (CNPI-Long Scale) based on both inductive and deductive processes to assess attitudes and behaviours associated with Watson's 10 carative factors. Two issues led us to abridge our original 70-item scale into a more concise Short Scale (CNPI-Short Scale). First, many of our subscales were moderately to highly correlated, which is an empirical reflection of the theoretical non-independence of the carative factors. Secondly, a 70-item questionnaire was difficult to be deal with in the clinical research setting with severely ill patients because of its length. METHOD: Items selected were determined by factor analysis, with specific theoretical and empirical requirements. Data were collected in September 2003 from 377 nursing students beginning their first, second or third year of a nursing programme. RESULTS: The Short Scale comprises 23 items, reflecting four caring domains: Humanistic Care (four items), Relational Care (seven), Clinical Care (nine) and Comforting Care (three). All items are related to their theoretical domain alone (i.e. factor loading >or=0.40). Alpha coefficients for the four domains were adequate (0.63-0.74, 0.90-0.92, 0.80-0.94 and 0.61-0.76 respectively). CONCLUSIONS: The CNPI-Short Scale, has potential for use in clinical research settings, particularly when questionnaire length is an issue. It is a useful tool for research aimed at demonstrating that caring is indeed fundamental to nursing.

Efficacy of interventions in improving adherence to antiretroviral therapy.

The aim of this paper is to perform a critical review of the effectiveness of interventions for the purpose of enhancing adherence to antiretroviral therapy. The overall evaluation indicates that research is in its early stages. Although pilot studies provide support for the feasibility of their protocols, and preliminary results also suggest their capacity to improve adherence, only three major trials have reported significant improvement in adherence. The issues that will have to be addressed by future studies include: (a) the need for a theoretical and empirical understanding of the phenomena; (b) adoption of a format that fits the attributes of the population; (c) the use of multiple strategies involving key providers; (d) a concise and precise schedule governing the frequency and intensity of the intervention; (e) a careful selection of direct outcome; and (f) appropriate time measurement. In sum, greater efforts to design and evaluate interventions are needed to lead to an increase in adherence and improvement in treatment effectiveness.

Cognitive coping intervention for acutely ill HIV-positive men.

AIM: A nursing intervention was designed that is intended to develop, maintain and strengthen the patient's cognitive coping skills to regulate emotional response to severe physical symptoms. It was tested in a randomized trial reported elsewhere and this article describes the intervention and discusses its application. BACKGROUND: Research shows that psychological distress and depressive symptoms are likely to increase with the development of human immunodeficiency virus (HIV)-related physical symptoms. Nurses who work with HIV-positive individuals have an opportunity to influence their patients' health experiences substantially. CLINICAL APPLICATION: The intervention was carried out with hospitalized HIV patients who had to cope with an acute period of stress due to an exacerbation of HIV-related symptoms. The intervention was administered on three consecutive days, in 20-30-minute sessions. The features of the intervention in relation to two examples of patient profiles are described: patients needing to develop their cognitive skills to regulate severe emotional distress and patients with effective cognitive coping skills. RELEVANCE TO CLINICAL PRACTICE: The intervention empowers nurses by offering an effective approach to deal with individuals who are facing severe illness. It has also the potential to empower patients both to take advantage of their own personal resources and to take control over their situation.

A focus for nursing intervention: realistic acceptance or helping illusions?

Despite having a life-threatening disease, some people decide to live every remaining moment with intensity. Although they have accepted that their deaths might be imminent, they do not dwell on the possibility. They choose life and are sustained by vivid thoughts and inspirations. What can a nurse do to nourish such thoughts? Traditional theories of grief and loss maintain that one way to adjust to advanced stages of progressive disease is to accept death and prepare for it. Is it possible that these theories are simplistic and limiting in their assumptions about the way people "work through" the stage of adjusting to loss? This article is a critical reflection of the process.

Factors affecting adherence to antiretroviral therapy in people living with HIV/AIDS.

Antiretroviral treatments have given hope to people living with HIV/AIDS and play a role in improving their quality of life. However, the effectiveness of these treatments is directly related to the level of adherence and commitment to them. Researchers have demonstrated that there are many factors that play an important role in adopting and maintaining adherence behavior. In this article, the authors present an indepth review of the literature and from this, enumerate the factors that link adherence behavior to the individual, the treatment, the illness, and the relationship with the health professional. An understanding of these factors is essential to develop interventions that will improve adherence to therapeutic regimens among people with HIV/AIDS.

A randomized trial of a cognitive coping intervention for acutely ill HIV-positive men.

BACKGROUND: People who are HIV-positive now live longer when they have contracted AIDS, and nursing interventions can help improve their quality of life. OBJECTIVES: To test the effects of an intervention based on developing cognitive coping skills as compared to one focused on facilitating the expression of emotions. Both interventions were intended to help regulate emotional response to an exacerbation of HIV-related symptoms. METHOD: In a randomized, controlled trial, 90 hospitalized HIV-positive men were randomly assigned to one of three groups: cognitive, expression, or control. The intervention was administered on three consecutive days in 20-30 minute sessions. Preintervention and postintervention data were gathered on mood, distress, and anxiety. RESULTS: Both interventions produced a beneficial effect on negative affect (cognitive group p =.002, expression group p =.011), and immediately following the first daily session (p =.001). No change in positive affect was produced by either intervention. Paired t tests indicated a decrease in distress (p =.039), specifically, of intrusive ideation (p =.03), for the cognitive group, which also experienced a decrease in anxiety from immediately before to immediately after each session. Conversely, the expression group experienced an increase in anxiety (p =.018). DISCUSSION: The cognitive coping skills nursing intervention was effective in helping to regulate HIV-positive persons' emotional responses to advanced disease. This nursing intervention is feasible for use by skilled practitioners providing daily care.