Social problem-solving telephone partnerships with family caregivers of persons with stroke.

As individuals with significant functional deficits are discharged earlier from the hospital, health care professionals are challenged to develop cost-effective intervention programmes that will assist family members to manage caregiving problems in the home. The literature suggests that social problem-solving can positively influence the physical and psychological well-being of individuals. This paper describes a social problem-solving training procedure provided primarily by telephone to assist family caregivers to manage caregiving issues in the home.

Sociodemographic, physical, and psychosocial characteristics of depressed and non-depressed family caregivers of stroke survivors.

A variety of sociodemographic, physical, and psychosocial variables are linked to depressive behaviour in family caregivers. This study was conducted to determine the best predictors of caregiver depression at onset of the caregiver role among persons providing care to a stroke survivor. The relative contributions of stroke survivor and caregiver sociodemographic characteristics, as well as caregiver general health, physical functioning, social support, life satisfaction, preparedness, and reaction in the prediction of depression status, were examined. A correlational study of 52 primary family caregivers of individuals who had a cerebrovascular accident was conducted. General health and physical functioning scales from the SF-36, and measures of caregiver social support, life satisfaction, preparedness, and reaction were used. Caregiver depression was best predicted by lower life satisfaction, lower physical functioning, and a lack of tangible social support.

Social problem-solving partnerships with family caregivers.

The goal of this pilot study was to compare the effectiveness of home and telephone social problem-solving partnerships on primary family caregiver outcomes and to determine whether certain caregiver and stroke survivor characteristics influenced these outcomes. Thirty primary family caregivers were assigned to either a home visit, telephone contact, or control group. A registered nurse trained caregivers in the intervention groups in a series of seven telephone calls or home visits during a 12-week period to use social problem-solving skills in managing caregiving problems. Primary family caregiver outcomes were compared before the intervention, during the intervention (at 2 and 5 weeks after discharge), and after the intervention (at 13 weeks after discharge). Compared to the home and control groups, the telephone group had a significant reduction in depression, more positive problem-solving skills, and greater caregiver preparedness during the intervention, and improved, but nonsignificant depression, problem-solving, and caregiver preparedness scores postintervention. Race, age, and education were significant for selected outcomes.

Recruiting and retaining research participants for a clinical intervention study.

This article describes strategies investigators can use to recruit and retain research participants in a clinical intervention study. Although specific issues and examples focus on family caregivers of stroke survivors, many strategies discussed here are applicable to other populations.

Writing manuscripts for clinical journals.

Publishing in clinical journals can be an exciting and rewarding opportunity for home care nurses to convey creative ways they address problems in their practice. This article provides strategies potential authors can use to select topics, develop content, adhere to appropriate format and style, and benefit from pre- and postsubmission manuscript critiques. An overview of the review and publication process is also discussed.

Selection and use of content experts for instrument development.

Content experts frequently are used in the judgment-quantification stage of content validation of instruments. However, errors in instrumentation may arise when important steps in selecting and using these experts are not carefully planned. The systematic process of choosing, orienting, and using content experts in the judgment-qualification stage of instrument development is addressed, with particular attention to the often neglected, important step of familiarizing these experts with the conceptual underpinnings and measurement model of the instrument. An example using experts to validate content for a measure of caregiver burden is used to illustrate this stage of instrument review.

Home care problems experienced by stroke survivors and their family caregivers.

The purpose of this qualitative study was to explore home care problems experienced by stroke survivors and their family caregivers after hospital discharge. Stroke survivors and family caregivers identified four major problems: loss of the stroke survivor's familiar identity, managing activities of daily living, seeking and mobilizing tangible services, and obtaining emotional/social support. Implications for home healthcare nurses are discussed for each problem.

Using the literature to design a study in the rehabilitation setting: an example with stroke patients.

A literature review can provide direction for decisions that are made at each step of the research process. Rehabilitation nurses can use a review of the research literature to provide the foundation for designing a clinical study. The purpose of this article is to describe how a literature review can contribute to designing nursing studies in rehabilitation care settings. Examples of the literature on discharge planning for stroke patients are used to illustrate this process.

Constructing the reality of recovery: family home care management strategies.

Development of home health care programs for family caregivers is predicated on an understanding of problems caregivers encounter and ways in which they manage those problems. This article describes home care management strategies of family caregivers of stroke survivors. Qualitative analysis of interviews with a purposive sample of family caregivers indicated that caregivers of stroke survivors practice situational vigilance for the stroke survivor, create solutions for problems associated with functional losses of a stroke, construct the reality of recovery for themselves and the stroke survivor, and seek to find personal meaning in the caregiving experience. Implications for practice and future research are proposed.

Criteria for critiquing clinical nursing research reports.

The primary goal of nursing research is to develop a scientific knowledge base for practice. Postanesthesia nurses are expected to critique nursing research before applying findings to clinical practice. As consumers of research, postanesthesia nurses must be able to employ critical evaluation skills to judge the merit and relevance of research to their clinical practice. This article presents criteria for critiquing clinical nursing research reports to determine their relevance to practice.

Guidelines for using psychometric consultants in nursing studies.

Consultation for measurement issues is an increasingly common expectation for many studies, yet there are few published guidelines on the use of psychometric consultants. The role of the psychometrician as research consultant is discussed and questions commonly asked of these measurement experts are identified. Consultation when selecting, revising, and developing data collection instruments is explored.

Using conceptual frameworks or models to guide nursing research.

To be useful, a frame of reference must enable an investigator to organize all components of a research study beginning with the literature review and problem statement and continuing through interpretation of findings. Careful conceptualization of the entire research process will move nurses closer to building an orderly system of scientific knowledge in which each investigation serves as a tool of nursing science.

Clinical referents for nursing diagnoses.

Validation of nursing diagnoses is an essential step in developing knowledge for nursing practice and should be a major goal of the discipline. Nursing diagnoses must have clinical referents, that is, defining characteristics which appear in patient populations exhibiting specific nursing diagnoses. Selecting nursing diagnoses for patient populations, developing a list of defining characteristics and operational definitions for a nursing diagnosis, selecting a standard to discriminate among subjects and constructing an instrument to document the occurrence of defining characteristics in selected patient populations are preliminary steps in identifying clinical referents. Methodological concerns addressed in establishing clinical referents for nursing diagnoses included controlling confounding factors, determining sample size, conducting a pilot study, determining interrater reliability, selecting appropriate statistical tests, and identifying critical defining characteristics for a nursing diagnosis.

Using the Delphi technique to examine the content validity of nursing diagnoses.

Official labeling of phenomena that nurses diagnose and treat requires that researchers validate the existence of proposed diagnoses. One part of the validation process is the examination of content validity. The Delphi technique is a useful methodologic technique for such an examination. This article describes the characteristics, background, advantages, and disadvantages of the Delphi technique, as well as suggested strategies for using it to validate nursing diagnoses. In discussing strategies for using the Delphi technique to validate nursing diagnoses, the format, essential components, and steps of each round of the traditional and modified Delphi procedure are addressed. Round I of the traditional Delphi technique involves selection of a panel of content experts, developing and mailing questionnaires and content analysis, and generating a list of defining characteristics and operational definitions for a nursing diagnosis. Round II involves developing and mailing questionnaires, determining percentage of agreement, and providing statistical analysis. Round III includes developing and mailing questionnaires and providing statistical analysis of data. Round IV consists of developing and mailing the final report, which includes a statistical summary of individual and grouped responses in round III, as well as a minority report. The format and statistical analysis of the modified Delphi procedure is similar to rounds II, III, and IV of the traditional Delphi technique, except the modified technique usually will require only three rounds.

The need for operational definitions for defining characteristics.

Although much attention has focused on the validation of defining characteristics for nursing diagnoses, equal attention has not been devoted to the development of operational definitions for defining characteristics. Operational definitions, however, provide a reference for determining whether defining characteristics are present in patients who participate in clinical validation studies. Validation of nursing diagnoses emerges from occurrence of the diagnostic label in clinical practice. Operational definitions provide the bridge between incidental observation and scientific validation of nursing diagnoses.

Neuroscience patients: under attack by fungi.

An intact skin with its acid mantle is the patient's first line of defense. Neuroscience nurses are the patient's second line of defense since they are responsible for assessment and treatment of the skin. Several risk factors make neuroscience patients susceptible to candidiasis. Skin properties, risk factors, assessment, complications and selected nursing and medical treatment of candidiasis are discussed in this article.

Altered level of consciousness: validity of a nursing diagnosis.

The purpose of this three-phase study was to examine the validity of the nursing diagnosis altered level of consciousness (ALC). The conceptual framework was diagnostic reasoning. In Phase I, 26 content experts certified in neuroscience nursing completed four rounds of a Delphi survey to identify defining characteristics and operational definitions for the nursing diagnosis. The diagnosis was divided into ALC: arousal and ALC: content. In Phase II, 30 staff nurses from two neuroscience intensive care units (NICUs) used the magnitude estimation scaling technique in judging the importance and frequency of occurrence of defining characteristics chosen in Phase I. In Phase III, 60 patients in two NICUs were assessed for frequency of occurrence of the defining characteristics for ALC: arousal and ALC: content. In Phase I, there was greater than or equal to 70% agreement on the appropriateness and clarity of 28 and 24 defining characteristics and operational definitions for ALC: arousal and ALC: content, respectively. In Phase II, there were 7 major defining characteristics identified for ALC: arousal and 6 major defining characteristics identified for ALC: content. In Phase III, there were 13 defining characteristics that occurred with significantly greater frequency in patients with an ALC: arousal and 17 defining characteristics that occurred with significantly greater frequency in patients with an ALC: content.

Using magnitude estimation scaling to examine the validity of nursing diagnoses.

This paper describes the use of magnitude estimation scaling in the validation of the critical defining characteristics of nursing diagnoses. Magnitude estimation is a sensitive and accurate technique producing ratio level scales that offer advantages over ordinal level scales frequently used in validating nursing diagnoses. Magnitude estimation responses permit a consensus pattern to be achieved by producing stable and repeatable judgments to validate the importance of each sign and symptom investigated. Thus, magnitude estimation shows promise as a methodologic strategy for validating the critical defining characteristics of nursing diagnoses, thereby expanding the effort to identify and classify nursing phenomena.