Traveling the road toward academic promotion for faculty with a DNP degree.

There is a widely recognized need for nursing faculty in the United States. To prepare a practice-ready workforce, schools of nursing are hiring faculty with Doctor of Nursing Practice (DNP) preparation to ensure clinical expertise is embedded into curriculum by practice experts. However, nurses transitioning from clinical nursing to faculty positions require tailored support and guidance in navigating the academic environment. Preparation for academic promotion is essential to integration into an academic setting. Support in navigating the new environment is essential for building confidence, to lay a foundation for a successful transition, and ultimately retaining these qualified educators. This article provides strategies to support nursing faculty planning to embark on an academic career track and provides guidance on how to prepare these DNP-prepared faculty for career progression and future promotion along academic ranks. These strategies include school and institutional orientation, faculty development plans, mentorship, leadership development, and performance review processes.

Self-care Problems and Management Strategies Experienced by Rural Patient/Caregiver Dyads Living With Heart Failure: A Qualitative Study.

BACKGROUND: Rural patients with heart failure (HF) have higher mortality and hospitalization rates compared with their urban counterparts. Although research supports the inclusion of informal caregivers in daily self-care activities, data are limited regarding the problems encountered by rural patient/caregiver dyads living with HF in managing HF in the home and how these problems are managed. OBJECTIVE: The aim of this study was to identify and describe HF self-care problems experienced by rural dyads in the home and how these problems are managed. METHODS: Using a descriptive qualitative design, data were collected from rural patient/caregiver dyads living with HF via individual, semistructured, telephone interviews and analyzed using schematic content analysis. Interviews and data analysis occurred concurrently until data saturation was reached. RESULTS: Thematic data saturation was obtained with 11 dyads. On average, patients were 65.3 (±13.9) years old, and caregivers were 62 (±12.37) years old. Four themes illustrating dyadic HF self-care problems and management strategies emerged: (1) HF self-care components, namely, maintenance, symptom monitoring, and management (diet, exercise, activities, strategies); (2) environment (rural barriers, COVID-19); (3) caregiver contributors (confidence, role); and (4) dyadic contributors (dyadic relationship). Dyads described various self-care problems, with the type of relationship and presence of mutuality influencing the problem-solving process and development of management strategies. CONCLUSIONS: The identified themes emphasize the self-care problems experienced by rural dyads living with HF and the contributions of both dyad members to effectively manage these challenges. Findings support the need for culturally sensitive, tailored interventions targeting self-care in rural dyads living with HF.

Medications Cost Resources.

High cost of prescription drugs is a common reason why patients stop taking medications, or don't fill a prescription. There are cost savings plans available, but these resources vary by eligibility criteria, and each has advantages and disadvantages. The article reviews some of the available cost saving options.

The role of caregiving in cognitive function and change: The REGARDS study.

Chronic stress is associated with negative health outcomes, including poorer cognition. Some studies found stress from caregiving associated with worse cognitive functioning; however, findings are mixed. The present study examined the relationship between caregiving, caregiving strain, and cognitive functioning. We identified participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were family caregivers at baseline assessment and used propensity matching on 14 sociodemographic and health variables to identify matched noncaregivers for comparison. Data included up to 14 years of repeated assessments of global cognitive functioning, learning and memory, and executive functioning. Our results showed that when compared to noncaregivers, caregivers had better baseline scores on global cognitive functioning and word list learning (WLL). Among caregivers, a lot of strain was associated with better WLL and delayed word recall in the unadjusted model only. Caregivers with a lot of strain had higher depressive symptoms but not significantly higher high-sensitivity c-reactive protein (hsCRP) at baseline compared to caregivers with no or some strain after covariate adjustment. Although caregiving can be highly stressful, we found caregiving status and caregiving strain were not associated with cognitive decline. More methodologically rigorous studies are needed, and conclusions that caregiving has negative effects on cognition should be viewed with caution. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Subjective Component of the Dutch Objective Burden Inventory: A Psychometric Analysis.

BACKGROUND: The reliability and validity of the subjective component of the Dutch Objective Burden Inventory (DOBI) are unknown. OBJECTIVE: The validity and reliability of the subjective component of the DOBI were examined in caregivers of individuals with heart failure, using the original 38- and a 24-item version. METHODS: In an online cross-sectional investigation, confirmatory factor analysis was used to examine factorial validity. In examining convergent validity, corrected item-dimension correlations assessed item performance and associations between subjective subscale scores and the Bakas Caregiving Outcomes Scale. Cronbach's α examined internal consistency. RESULTS: The original 4-factor solution was retained and both the original and shorter versions of the subjective component of the DOBI supported adequate construct validity and internal consistency. CONCLUSIONS: Both the 38- and 24-item forms of the subjective DOBI supported construct validity and reliability. Further studies examining the usefulness of both versions are needed in carers of individuals with more severe HF.

Classifying Heart Failure Caregivers as Adequately or Inadequately Resourced to Care: A Latent Class Analysis.

OBJECTIVES: To identify classes of heart failure (HF) caregivers based upon indicators of coping resources and stress, and then, to examine the relationships between the identified caregiver classes and depression, caregiver burden, and life changes. METHODS: Cross-sectional data from 530 HF caregivers were analyzed in this secondary analysis using a three-step latent class mixture model to classify caregivers based on level of resources and examine the relationship between the identified classes and depression, caregiver burden, and life changes. Using an online survey, caregivers reported on social support, problem-solving, family function, depression, caregiver burden, and life changes. RESULTS: Caregivers were 41.39 (± 10.38) years of age, 49.1% women, 78.3% white, 77.6% urban-dwelling, and 61.7% college/postgraduate educated. Three classes of caregivers (42.3% Adequately Resourced, 25.1% At Risk for Decompensation, 32.6% Inadequately Resourced) were identified. Inadequately Resourced caregivers had the lowest levels of social support, problem-solving, and family function and the highest levels of depression and caregiver burden. Caregivers At Risk for Decompensation had the best family function and reported the most positive perceptions of life changes despite low levels of social support and problem-solving. CONCLUSION: Social support, problem-solving, and family function are modifiable coping resources which may buffer stress and influence stress indicators. Caregivers with few coping resources may experience higher degrees of depression and burden, and less positive perceptions of life changes. More research is needed to examine the influence of these coping resources on caregiver adaptation to facilitate the development of targeted interventions which support caregiver mental health.

Psychosocial predictors of adverse outcomes in rural heart failure caregivers.

INTRODUCTION: Depressive symptoms, negative life changes, poor self-care, and higher caregiver burden are common in caregivers who assist individuals with heart failure (HF) in managing daily activities and disease-related symptoms. Previous research findings suggest social support, problem solving, and family function may influence these outcomes. However, the influence of these factors on outcomes in rural HF caregivers is unknown. The purpose of this study is twofold: (1) to examine whether social support, problem solving, and family function predicted depressive symptoms, caregiving-related life changes, self-care, and caregiver burden in rural HF caregivers; and (2) to compare differences in these variables between rural and urban caregivers. METHODS: Rural caregivers (n=114) completed an online researcher-developed sociodemographic and clinical survey and standardized (Likert-type) self-report instruments. Participants were recruited locally from south-eastern USA (using face-to-face and telephone contacts, posted flyers, newspaper advertisements, and social media), nationally (newspaper advertisements and social media sites) and internationally (using social media). Potential participants were directed to the study website to complete the online surveys. These methods recruited participants who lived in 24 states within the USA, as well as from Canada, England, Ireland, Scotland, and Wales. Demographic statistics and Mann-Whitney U-test, as well as bivariate correlations, multivariate linear modelling, and Roy's largest root, were used to analyse data, controlling for covariates. RESULTS: Rural (n=114) caregivers were primarily Caucasian (84.2%), women (58.8%), and 41.45 (±9.013) years old. Social support had significant effects on depressive symptoms (ηp2=0.384, p<0.001), self-care (ηp2=0.108, p=0.001), and life changes (ηp2=0.055, p=0.016), while problem solving showed significant effects on depressive symptoms (ηp2= 0.078, p=0.004) and caregiver burden (ηp2=0.23, p<0.001). Family function had significant effects on life changes (ηp2=0.104, p=0.001), self-care (ηp2=0.088, p=0.002), and caregiver burden (ηp2=0.116, p<0.001). Compared to urban (n=412) participants, rural caregivers experienced significantly less social support (p=0.001), worse problem-solving skills (p=0.003) and family functioning (p=0.009), and greater depressive symptoms (p≤0.01) and subjective burden (p=0.001). There were no significant differences in caregiver self-care (p=0.416) and perceived life changes (p=0.346) among rural and urban caregivers. CONCLUSION: Both social support and problem solving have significant effects on depressive symptoms in rural HF caregivers, while social support and family function influences self-care. Problem solving and family function also affect caregiver burden, while social support and family functioning influences caregiver life changes. Rural caregivers are often separated by long distances, and have transportation issues and limited access to healthcare providers and support services; therefore, innovative strategies are needed to explore the usefulness of these variables in improving caregiver outcomes.

Heart Failure Caregiver Self-Care: A Latent Class Analysis.

Little is known about heart failure (HF) caregiver self-care. This article reports a secondary analysis of data from a cross-sectional, descriptive study involving 530 HF caregivers. A three-step latent class mixture model identified HF caregiver classes at risk for poor self-care and examined the relationship between the identified self-care classes and caregiver burden and depression. Caregivers completed online surveys on self-care, caregiver burden, depression, problem-solving, social support, and family function. Caregivers were 41.39 (±10.38) years old, 78.3% Caucasian, and 50.9% men. Three classes of HF caregivers (24% Low-Risk, 24.9% Moderate-Risk, 51.1% High-Risk) were identified. High-Risk caregivers had the worst self-care and the lowest levels of social support, problem-solving, and family function. Moderate-Risk caregivers were the most experienced and had the best self-care yet had the most comorbidities. High-Risk caregivers reported more caregiver burden and depression. "At-risk" caregivers may benefit from self-care and support programs, but more research is needed.

Psychometric Examination of the Dutch Objective Burden Inventory in Heart Failure Caregivers.

BACKGROUND: Psychometric properties of the 38-item version of the Dutch Objective Burden Inventory (DOBI) have been evaluated primarily in older female caregivers, with no published studies that vary by a different gender and age distribution. OBJECTIVE: The aim of this study was to test the construct validity and reliability of the DOBI in caregivers of individuals with heart failure from the United States and other countries. METHODS: This secondary analysis from a cross-sectional study used an online survey. Factorial validity was tested with confirmatory factor analysis, item performance was examined with ordinal item response analysis, and convergent validity was tested correlating DOBI subscale scores with Bakas Caregiving Outcomes Scale scores. Internal consistency reliability was assessed with Cronbach α. RESULTS: Item response analysis removed 14 items. Confirmatory factor analysis retained the original 4-factor solution. Original and reduced instruments demonstrated good internal consistency. Validity was supported by meaningful associations with the Bakas Caregiving Outcomes Scale. CONCLUSIONS: Both the original 38-item DOBI and the reduced 24-item DOBI had support for their construct validity and internal consistency. The 24-item DOBI may be a useful alternative to the 38-item version, because it maintains psychometric properties of the original instrument while decreasing data collection burden. However, more research is needed to assess whether the shorter version is useful in assessing objective caregiving burden.

Psychosocial Factors Related to Adverse Outcomes in Heart Failure Caregivers: A Structural Equation Modeling Analysis.

BACKGROUND: Heart failure (HF) caregivers experience increased demands and burden. Social support and problem solving may influence the effect of these variables on caregiver outcomes. OBJECTIVE: The aim of this study was to examine whether social support and problem solving mediate relationships among caregiver demands and burden, self-care, depression, and life changes in heart failure caregivers. METHODS: Using a cross-sectional, exploratory design, heart failure caregivers (n = 530) completed online questionnaires on caregiver demands and burden, social support, problem solving, depression, self-care, and life changes. Path analysis examined a hypothesized mediating role of social support and problem solving in the relationships among caregiver demands and burden and caregiver outcomes. The analysis included (1) a model-development phase (n = 329) to make data-based decisions on measurement indicators and model structure and (2) a confirmatory phase (n = 201) to provide unbiased inference on the model structure resulting from the initial phase. RESULTS: Participants were 41.39 (±10.38) years old and primarily white (78.3%) men (50.9%) caring for a spouse (44.9%). Per the magnitudes of the estimated path coefficients, social support mediated the relationship between caregiver burden and depression but did not relevantly mediate the relationship between caregiver burden and self-care or caregiver life changes. In the presence of social support as a parallel mediator, problem solving was not a relevant mediator between caregiver burden and demands and caregiver outcomes. CONCLUSIONS: Social support mediates the effects of caregiver burden on depression but has little effect on self-care or life changes. In the presence of social support, problem solving does not mediate the effects of caregiver demands and burden on caregiver outcomes.

Predictors of Depressive Symptoms in Heart Failure Caregivers.

Heart failure is a serious and complex chronic illness and family caregivers often assist these individuals in performing self-care. Unsurprisingly, caregivers often are overwhelmed by daily activities associated with heart failure management and frequently have depressive symptoms. This study examined predictors (i.e., sociodemographic and clinical characteristics, social support, social problem-solving, family functioning, and objective and subjective burden) of depressive symptoms in 530 informal caregivers of individuals with heart failure in a large cross-sectional, descriptive study in the community. Younger caregivers who provided care for longer periods of time, lived in rural areas, and had less social support and lower problem-solving skills were more likely to have depressive symptoms. These findings emphasize the need for further studies to develop dynamic and innovative approaches that incorporate multiple components to lessen caregiving challenges. Social support and problem-solving skills training may be useful components to lessen depressive symptoms in these younger, rural caregivers.

Problems experienced by informal caregivers of individuals with heart failure: An integrative review.

OBJECTIVES: The purpose of this review was to examine and synthesize recent literature regarding problems experienced by informal caregivers when providing care for individuals with heart failure in the home. DESIGN: Integrative literature review. DATA SOURCES: A review of current empirical literature was conducted utilizing PubMed, CINAHL, Embase, Sociological Abstracts, Social Sciences Full Text, PsycARTICLES, PsycINFO, Health Source: Nursing/Academic Edition, and Cochrane computerized databases. 19 qualitative, 16 quantitative, and 2 mixed methods studies met the inclusion criteria for review. REVIEW METHODS: Computerized databases were searched for a combination of subject terms (i.e., MeSH) and keywords related to informal caregivers, problems, and heart failure. The title and abstract of identified articles and reference lists were reviewed. Studies were included if they were published in English between January 2000 and December 2016 and examined problems experienced by informal caregivers in providing care for individuals with heart failure in the home. Studies were excluded if not written in English or if elements of caregiving in heart failure were not present in the title, abstract, or text. Unpublished and duplicate empirical literature as well as articles related to specific end-stage heart failure populations also were excluded. Methodology described by Cooper and others for integrative reviews of quantitative and qualitative research was used. Quality appraisal of the included studies was evaluated using the Joanna Briggs Institute critical appraisal tools for cross-sectional quantitative and qualitative studies. RESULTS: Informal caregivers experienced four key problems when providing care for individuals with heart failure in the home, including performing multifaceted activities and roles that evolve around daily heart failure demands; maintaining caregiver physical, emotional, social, spiritual, and financial well-being; having insufficient caregiver support; and performing caregiving with uncertainty and inadequate knowledge. CONCLUSIONS: Informal caregivers of individuals with heart failure experience complex problems in the home when providing care which impact all aspects of their lives. Incorporating advice from informal caregivers of individuals with heart failure will assist in the development of interventions to reduce negative caregiver outcomes. Given the complex roles in caring for individuals with heart failure, multicomponent interventions are potentially promising in assisting informal caregivers in performing these roles.

Problems Experienced in the First Month After Discharge From a Heart Failure-Related Hospitalization.

PURPOSE: Heart failure is a global health concern with high morbidity and mortality rates. Individuals with heart failure commonly experience problems that impact daily life. However, little is known regarding which problems are most significant during the immediate posthospitalization period. Thus, the purpose of this study was to identify high-priority problems experienced by individuals the first month after discharge from an acute care facility with a diagnosis of heart failure. METHODS: This descriptive, exploratory study was part of a 12-week randomized controlled pilot study that examined the efficacy of a coping partnership intervention (COPE-HF Partnership) between a trained research nurse and individuals with heart failure in managing self-care and depressive symptoms. Data from participants randomized to the intervention group (N=19; 58% Caucasian, 58% male) were used in this study. Participants were provided a list of potential heart failure-related problems, from which they identified those of highest priority. Content and quantitative data analysis was conducted. RESULTS: Difficulty in managing heart failure symptoms, adhering to treatment plan, completing daily activities, and experiencing negative emotions and moods were the most common problems experienced by individuals with heart failure. Other less common problems for the group were inadequate resources and managing interpersonal issues. CONCLUSIONS: Individuals with heart failure experience complex problems in the home that impact all aspects of their lives. Incorporating strategies to address these problems could assist in the development of interventions to reduce negative heart failure outcomes.

Problems Experienced in the Second and Third Months After Discharge From a Heart Failure-Related Hospitalization.

The purpose of this study was to identify high-priority problems experienced by individuals during the second and third month after discharge from an acute care facility for heart failure. This descriptive, exploratory study, an extension of a previous analysis that examined high-priority problems in the first month, comprised 19 participants who were assigned to an intervention group that received a randomized, 12-week-pilot coping partnership (COPE-HF) intervention. A trained research nurse provided the intervention, and participants used a standard list to identify high-priority heart failure-related problems. Quantitative and content data analysis was conducted. While the highest-priority problem continued to be managing their treatment regimens, the frequency of this problem lessened by week 12. Comorbidities emerged as a new problem in managing heart failure treatment and symptoms. Coping emerged as a new problem, as individuals with heart failure dealt with the impending morbidity of their diagnosis and how it would affect loved ones. Resource issues (ie, financial, social) became more prevalent for individuals with heart failure as potential and actual resources were depleted. Health providers should develop strategies to address these problems to improve outcomes in individuals with heart failure.

Progressing From Metformin to Sulfonylureas or Meglitinides.

The article provides an overview of sulfonylureas and meglitinides as second-line agents for treating type 2 diabetes mellitus (T2DM). Implications for occupational health clinicians who work with these individuals when they take either of these medications to achieve target glycemic indices are emphasized.

Barriers to Diabetes Self-Management Among Rural Individuals in the Workplace.

Higher rates of type 2 diabetes mellitus (T2DM) are found in rural populations and barriers lessen the ability of these individuals to effectively manage diabetes. By lessening potential barriers to self-care management, health professionals, especially occupational health nurses, can assist individuals confidently manage T2DM. In this article, the authors provide an overview of diabetes self-management barriers for rural populations and implications for health professionals who assist individuals with T2DM in the workplace.

Symptomatology and Coping Resources Predict Self-Care Behaviors in Middle to Older Age Patients with Heart Failure.

Background. Symptoms of heart failure (HF) and coping resources, such as social support and social problem-solving, may influence self-care behaviors. Research regarding the influence of HF symptomatology characteristics and components of social support and social problem-solving on self-care is limited. Objective. To identify predictors of HF self-care behaviors using characteristics of HF symptomatology, components of social support and social problem-solving, and demographic and clinical factors. Methods. Using a cross-sectional, correlational predictive design, a convenience sample (N = 201) of outpatients with HF answered self-report surveys. Multiple linear regression with stepwise variable selection was conducted. Results. Six predictors of HF self-care were identified: race, symptom frequency, symptom-related interference with enjoyment of life, New York Heart Association Class HF, rational problem-solving style, and social network (ß = 34.265, R (2) = 0.19, P = 0.001). Conclusions. Assessing the influence of race on self-care behaviors in middle to older age patients with HF is important. Clinical assessment that focuses on symptom frequency, symptom-related interference with enjoyment of life, and HF Class might also impact self-care behaviors in this population. Rational problem-solving skills used and evaluation of the size of and satisfaction with one's social network may be appropriate when assessing self-care.