Spiritual Needs of Older Adults in Long-Term Care: The Nurse's Role.

In this article we examine the nurse's role in assessing the spiritual needs of older adults in long-term care. The spiritual needs of older adults have not been adequately addressed in nursing care planning, and this has diminished the quality of care for residents in long-term care facilities. Understanding spirituality as a coping mechanism or social support intervention for older adults would be helpful to nurses who provide care to geriatric residents. Based on the literature, several topics of significance are discussed, including definitions of spirituality and religion, cultural considerations, research on spirituality as a coping mechanism and social support intervention, spiritual assessment models, and nurses' use of spirituality and religion in planning holistic care for long-term residents.

Beauty for Ashes: A Church-Based Diabetes Care Program.

The pilot study described here was a test of interventions designed to enhance long-term disease management of African-Americans with type 2 diabetes in faith-based organizations. A quasi-experimental design based on 46 participants was used comparing three interventions: guided imagery, group counseling, and routine care. Unexpectedly, the number of self-reported hypoglycemic episodes significantly increased in the Rational Emotive Behavioral Therapy (REBT) group, depressive symptoms significantly increased in the guided imagery group, and the mean hemoglobin A1c values did not significantly differ for any group. In future research, the authors will incorporate an interim step investigating the theory of integration (Hernandez, Antone, & Cornelius, 1999) to increase the explanatory power in assessing treatment effects of African-Americans in faith-based organizations.

Effort, workload, and depressive symptoms in family caregivers of older adults: conceptualizing and testing a work-health relationship.

Increasing effort in response to a complex workload is detrimental to workers' health and may explain the negative health consequences experienced by millions of family caregivers who are the primary workforce for older adult care in the United States. This cross-sectional, descriptive correlational study used survey data from 110 family caregivers of community-dwelling older adults to theoretically explain caregiving effort (as perceived exertion) and to examine the relationship between effort and depressive symptoms, a particularly persistent adverse caregiver health outcome. Visual analog scales and exemplar quotes explicated physical, mental, emotional, and time-related effort. Notably, effort was considered too multidimensional by several caregivers to discretely categorize. Among the relationships tested, effort was statistically significantly correlated with workload proxies (time, difficulty, overload), caregiver health and depressive symptoms, and care receiver function. Using regression analysis, effort and workload did not have direct effects on depressive symptoms. Surprisingly, effort was not decreased for caregivers who had formal or informal caregiving help. These findings support an energetical conceptualization in caregiving and highlight the complexity of a caregiving workload assessment. Practice suggestions are offered toward tailored health promotion strategies to benefit the families who constitute this essential, global caregiving workforce.

Internet versus face-to-face therapy: emotional self-disclosure issues for young adults.

The purpose of this study was to compare differences in emotional self-disclosure between young adult Internet users who prefer face-to-face therapy to those who prefer Internet therapy. A convenience sample of 328 was recruited from Facebook to complete an online survey. A total of 263 preferred face-to-face therapy (F2FT) while 65 preferred Internet therapy (IT). Significant differences were found with the F2FT group willing to disclose emotions of depression, jealously, anxiety, and fear to a therapist more frequently than the IT group. The majority reported a preference for F2FT over IT. Recommendations for future professional practice and research are included.

Milieu change and relocation adjustment in elders.

Relocation is a major life event for elders and has been found to adversely affect their adjustment and ability to perform daily activities. Rosenbaum's theory of learned resourcefulness suggests that such adverse effects can be minimized if elders have positive cognitions and are resourceful. A cross-sectional design was used to examine the hypothesized relationships among the study variables in a sample of 104 cognitively unimpaired elders (aged 65+ years) who have relocated to retirement communities in Northeast Ohio. Results indicate that positive cognitions had a direct positive effect on learned resourcefulness and on relocation adjustment. Furthermore, learned resourcefulness had a moderating effect on the relationship between relocation controllability and relocation adjustment when controlling for covariates. It is imperative to generate interventions to enhance positive thinking and learned resourcefulness for elders facing the need to relocate and to create the therapeutic milieu within the retirement communities.

Effects of social support and coping of family caregivers of older adults with dementia in Taiwan.

The purpose of this study was to explore the relationship of demographic characteristics, contextual factors, social support, and coping on health outcomes of family caregivers of older adults with dementia in Taiwan. This study also examined caregiving stress and whether support moderated the effects of caregiver stress on health. Lazarus and Folkman's (1984) Stress model guided this study. The descriptive cross-sectional study included subjects who were primary family caregivers of older adults with dementia from two settings in southern Taiwan. A convenience sample of 148 participants was interviewed. Data analysis consisted of Pearson's correlations, and simple and multiple regression analysis. Findings indicated that younger caregivers, those with paid assistants, and those with longer duration of caregiving had better health. Females with lower income and without assistants had more depressive symptoms. In addition, moderating effects of social support were supported. The results from this study provided a basis for developing interventions to minimize negative impacts on caregivers.

The effect of a feeding skills training program for nursing assistants who feed dementia patients in Taiwanese nursing homes.

A quasi-experimental 2-group repeated-measures design was used to test the impact of a feeding skills training program on 67 nursing assistants (treatment group n = 31; control group n = 36) regarding their knowledge, attitudes, perceived behavior control, intentions, and behaviors in feeding dementia patients. The treatment group received a feeding skills training program. Nursing assistants' knowledge, attitudes, perceived behavior control, and intentions were measured before (Pretest) and after the program (Posttest 1), and again 4 weeks later (Posttest 2). Nursing assistants (treatment group n = 20; control group n = 16) and the same number of dementia patients were measured on feeding behaviors during mealtimes before and after the training. The treatment group had significantly more knowledge (P < .001), greater intention to feed (P = .05), and better behaviors toward feeding dementia patients (P = .009) than the control group. There were no significant differences between the groups in attitude (P = .85), intention beliefs (P = .11) or perceived behavior control (P = .99). Thus, the intervention was effective at changing knowledge, intention, and behaviors among nursing assistants.

Perceived health status and health-promoting behaviors of African-American and White informal caregivers of impaired elders.

Caregiving and its consequences are major concerns for nurses. Many studies have examined health-promoting behaviors in general (Duffy, 1993; Walker, Volkan, Sechrist, & Pender, 1988), but few studies have explored health-promoting behaviors of caregivers. The purpose of this study was to examine the effects of age, gender, race, and length of caregiving on perceived health status and health-promoting behaviors of African-American and White informal caregivers of impaired elders. Data from a larger study was used to examine a conceptual model linking perceived health status and health-promoting behavior. A sample of 136 (n = 136) African-American and 257 (n = 257) White caregivers was recruited from northeastern Ohio through random digit dialing and interviewed face to face. English-speaking caregivers were selected for study who provided unpaid assistance or care for a minimum of five hours a week to an impaired person 60 years of age or older living in the community. The Health-Promoting Behavior Questionnaire, perceived health status, and a demographic profile were used to measure the study variables. Data were analyzed using hierarchical multiple regression. Findings from this study suggest that the overall fit of the conceptual model was significant, and that moreover, the relationship found between perceived health status and health-promoting behaviors supported Pender's model of health promotion (Pender, 1987). The relationship between perceived health status and health-promoting behaviors has not been documented in prior studies of caregivers, or in studies comparing the two racial groups of African-Americans and Whites.

Predictors of resourcefulness in African American women.

UNLABELLED: Although resourcefulness may facilitate coping with caregiver stress and burden, it has not been among African American women for whom caregiving is culturally prescribed. OBJECTIVE: Using Rosenbaum's theory of resourcefulness, this study examined situational (socioeconomic status, social support, daily hassles), physiological (age, body mass index, number of health problems, systolic blood pressure), and psychological factors (positive cognitions) as predictors of resourcefulness. METHODS: A random sample of 97 African American caregivers and 110 noncaregivers provided data via structured interviews and 24-hour ambulatory blood pressure monitoring. RESULTS: No physiological indicators predicted resourcefulness; however, daily hassles, social support, and positive cognitions were significant predictors. Age, number of health problems, daily hassles, and social support had indirect effects on resourcefulness through positive cognitions. DISCUSSION: These findings suggest a need to further examine the impact of daily hassles, social support, and positive cognitions on caregiving and continued review of models for predicting resourcefulness in African American women.

Predictors of health-promoting behavior of African-American and white caregivers of impaired elders.

Several longitudinal studies have examined declines in health of caregivers, but few have explored the health-promoting behavior Because caregivers neglect their health, they are at risk for developing a number of physical and psychological problems. What is not well known are the factors that contribute to increased health-promoting behavior ultimately preventing poor health and premature death. Therefore, the purpose of this study was to explore the predictors and the change in predictors of health-promoting behavior in African-American and White caregivers over a 3-year period. Pender, Murdaugh, and Parsons' (2002) health promotion model guided the study. This present study is a secondary data analysis of a larger study aimed at examining predictors of health-promoting behavior among 66 African-American (n=66) and 110 (n=110) and White caregivers of impaired older adults recruited primarily through random digit dialing. The larger data set consisted of 391 (N=391) subjects (n=136 African-American; n=255 White). The larger prospective study was based on face-to-face interviews. In the original study, trained interviewers collected data on depression, psychological distress, self-perceived health, religiosity, number of chronic conditions, and demographic characteristics using well-established instruments. Data in this present study were collected at three time points over a three-year period with one-year intervals at Time1 (T1), Time2 (T2), and Time3 (T3). Analysis of the data in this present study suggested that, although, the number of health-promoting behaviors significantly differed for African-American and White caregivers at T1, T2, and T3, no predictors were significantly associated with a change in health-promoting behavior over time. Nonetheless, this finding suggests that nurses can develop useful information in helping to focus more attention on the health of caregivers in the future.

Predictors of social support, acceptance, health-promoting behaviors, and glycemic control in African-Americans with type 2 diabetes.

Chronic illness is particularly important in older African-Americans because this population comprises the fastest growing segment of that ethnic group. This study explored relationships among personal factors (education and co-morbidity), mental health, and physical functioning on social support, social support on acceptance and health-promoting behaviors, acceptance on health-promoting behaviors, and health-promoting behaviors on HgbA1c. Face-to-face interviews were conducted using a convenience sample of 63 African-Americans from a community clinic. Participants were asked their highest level of education and to indicate their chronic conditions. Other instruments used were: Health Survey (SF-36), Personal Resource Questionnaire (PRQ-85), Revised (IAD-R) scale (Acceptance), and Health-Promoting Lifestyle Profile II. Glycemic control was measured using glycosylated hemoglobin. Physical functioning was the only significant predictor of social support (beta = .30, p = .03). In turn, social support predicted acceptance (beta = .32, p = .01) and health behaviors beta = .39, p = .002).

Psychometric characteristics of the Depressive Cognition Scale in African American women.

Depression in African-American women frequently goes unnoticed and untreated since commonly used depression scales fail to focus on early symptom recognition, do not address contextual factors, and lack adequate psychometric testing in African-American women. This analysis of the Depressive Cognition Scale was conducted with 213 African-American female caregivers and noncaregivers. Alpha coefficients for both groups (alpha 's = .75 and .87) showed internal consistency. Correlations with resourcefulness, depression, and daily hassles scales in the expected directions demonstrated construct validity (R's = -.36, .26, and .31, respectively). Factor structures for caregivers and noncaregivers differed, suggesting certain depressive cognitions were strongly integrated into the caregiver role. As a reliable and valid measure of depressive cognitions, the DCS would be useful for early detection of depression in African-American women.