Mediating effects of sense of coherence on family caregivers' depressive distress while caring for terminally ill cancer patients.

BACKGROUND: The stress and coping theory suggests that the impact of caregiving on caregivers' life depends more on personal psychological resources (ie, sense of coherence [SOC]) than on objective caregiving demands or social resources. However, SOC's mediation roles in helping caregivers cope with the challenges of end-of-life care have never been explored. OBJECTIVE: The objective of this study was to evaluate the mediation effects of SOC on caregivers' depressive distress while providing end-of-life care. METHODS: The Center for Epidemiological Studies-Depression Scale scores from a convenience sample of 621 family caregivers were analyzed using structural equation modeling. We used the Sobel test to verify the significance of SOC's mediation effects on the relationships between identified stressors (objective caregiving demands, patient symptom distress), appraisals (confidence in caregiving, subjective caregiving burden), and caregivers' depressive distress. RESULTS: Sense of coherence mediated effects on relationships between Center for Epidemiological Studies-Depression Scale scores and subjective caregiving burden (P = .000), confidence in caregiving (P = .014), and objective caregiving demands (P = .000). Although the strength of SOC did not attenuate the impact of caregivers' perceived patient symptom distress on caregiver depressive distress, SOC mediated this effect secondarily through appraisals of subjective caregiving burden and confidence in caregiving. CONCLUSION: Personal psychological resources, as indicated by the strength of personal SOC, significantly mediated the effects of caregiving stressors, appraisals of caregiving confidence, and subjective caregiving burden on depressive distress of family caregivers while providing end-of-life care. IMPLICATIONS FOR PRACTICE: Nursing interventions to enhance caregivers' SOC may decrease their depressive distress through increasing their confidence in providing end-of-life care and lightening their perceived caregiving burden.

Characterisation and molecular epidemiology of extended-spectrum beta-lactamase-producing Enterobacter cloacae isolated from a district teaching hospital in Taiwan.

Enterobacter cloacae (n = 110) isolates from a district hospital in Taiwan were screened for extended-spectrum beta-lactamases (ESBLs). In total, 17 ESBL-producers were identified, based on the combination-disk synergy test using cefotaxime and ceftazidime +/- clavulanic acid. Investigation of ESBL genes in 33 ceftazidime-resistant isolates revealed the SHV-12 gene in the same 17 ESBL-producers. In addition, one isolate also carried the CTX-M-3 gene, and two isolates also carried the CTX-M-9 gene. No major epidemic clone of ESBL-producers was identified by pulsed-field gel electrophoresis. Routine screening for the ESBL phenotype, focusing on ceftazidime-resistant E. cloacae, should be undertaken in this area.