Betty L. Chang

Sleep and depression in cancer caregivers.

A cross-sectional, correlational design was used to describe and explore the relation between caregiver sleep and depression. For the study, 51 caregivers were recruited from two sites in southern California. Caregivers were primarily white (84%), female (80%), spouses (61%), or adult children (29%), who had provided care for a mean of 16 hours per day for an average of 2 years. The Center for Epidemiological Studies—Depression (CES-D) and the Pittsburgh Sleep Quality Index (PSQI) were used to measure caregiver depression and sleep, respectively. Most of the caregivers (95%) expressed severe sleep problems, and more than half of them were experiencing depressive symptoms at a level that would suggest risk for clinical depression. Correlations were strongest between caregiver depression and the sleep subscales of overall quality (r = 0.70;p < 0.001), habitual sleep efficiency (r = 0.54;p < 0.001), and daytime dysfunction (r = 0.59;p < 0.001). The final regression model, which included these subscales, predicted 63.6% of the variance in depression scores (F = 27.32;p < 0.001). These findings, which are consistent with results from other studies, suggest that caregivers of persons with terminal illness are at risk for clinical depression. It is critical for nurses to be cognizant of the relation between sleep problems and depression, and to explore interventions that would allow the caregivers to obtain needed sleep without diminishing their ability to function in their role as caregiver.

Cognitive-behavioral intervention for homebound caregivers of persons with dementia.

BACKGROUND Family caregivers experience considerable stress in their management of specific behaviors of persons with dementia. OBJECTIVE To examine the effects of an 8-week cognitive-behavioral (C-B) intervention tailored to the specific deficits of persons with dementia (PWDs) on selected outcomes for homebound caregivers and the functional status of the PWD. METHOD The design was a two-group randomized trial with measures taken at baseline, 4 weeks, 8 weeks, and 12 weeks. Subjects were 65 caregiver-care recipient dyads. A majority of the 65 female caregivers were spouses with a mean age of 66.5 years. Thirty-one women who received the C-B intervention were compared to 34 who received the attention-only (A-O) placebo telephone calls. Coping strategies, perceptions of caregiver burden and satisfaction, and emotional and physical health were assessed at the four points in time. RESULTS Results indicated a time by group interaction in depression, with less depression in the C-B than the A-O group. Both groups experienced a significant reduction in anxiety, and a significant consistent decrease in satisfaction over time. Both groups also demonstrated decreased use of emotion-focused coping strategies. CONCLUSION The results suggest a plausible effectiveness of the C-B intervention in preventing the progression of depression. Suggestions for future research are provided.

Predictors of Social Support and Caregiver Outcomes

SUMMARY Purpose: This study identified predictors of caregivers burden, satisfaction, depression, and social support. Little has been done to identify predictors of social support for caregivers at risk for negative outcomes. Design: Correlational descriptive study. Methods: A subset of interview data from a larger intervention study was utilized. Independent variables were caregiver/care-recipient characteristics and social support. Dependent variables included caregiver burden, satisfaction, depression, anxiety, and hostility. Results: Eighty-one caregiver/care-recipient dyads from the community participated in this study. Caregivers were women with a mean age of 67.53 years (range 39–86). Difficulty arranging assistance from confidante or friends correlated significantly and positively with caregiver burden (r = .38; p <.001) and depression (r = .34; p = .002), and negatively with satisfaction (r = −.28; p = .013). Findings/Implications: Arranging assistance is more important than frequency of social network contact with respect to burden and depression. The findings indicate a need for further investigation and the consideration of interventions for at risk caregivers.

Safety Assessment for the Frail Elderly: A Comparison of Restrained and Unrestrained Nursing Home Residents

Objective: To facilitate clinicians judgment concerning physical restraint decisions by identifying potentially reversible injury risk factors that differentiate representative samples of restrained and unrestrained nursing home residents.

Structured Implicit Review: A New Method for Monitoring Nursing Care Quality

Background.Nurses’ independent decisions about assessment, treatment, and nursing interventions for hospitalized patients are important determinants of quality of care. Physician peer implicit review of medical records has been central to Medicare quality management and is considered the gold standard for reviewing physician care, but peer implicit review of nursing processes of care has not received similar attention. Objective.The objective of this study was to develop and evaluate nurse structured implicit review (SIR) methods. Research Design.We developed SIR instruments for rating the quality of inpatient nursing care for congestive heart failure (CHF) and cerebrovascular accident (CVA). Nurse reviewers used the SIR form to rate a nationally representative sample of randomly selected medical records for each disease from 297 acute care hospitals in 5 states (collected by the RAND-HCFA Prospective Payment System study). Subjects.The study subjects were elderly Medicare inpatients with CHF (n = 291) or CVA (n = 283). Measures.We developed and tested scales reflecting domains of nursing process, evaluated interrater and interitem reliability, and assessed the extent to which items and scales predicted overall ratings of the quality of nursing care. Results.Interrater reliability for 14 of 16 scales (CHF) or 10 of 16 scales (CVA) was ≥0.40. Interitem reliability was >0.80 for all but 1 scale (both diseases). Functional Assessment, Physical Assessment, and Medication Tracking ratings were the strongest predictors of overall nursing quality ratings (P <0.001 for each). Conclusions.Nurse peer review with SIR has adequate interrater and excellent scale reliabilities and can be a valuable tool for assessing nurse performance.

Evaluating quality of nursing care: the gap between theory and practice.

The purpose of this article is to determine whether nursing practice, as judged by nurse peer reviewers, varies by type or location of hospital and to assess which aspects of practice tend to be most at variance with nursing theory. This article provides a framework of continued quality assessment and improvement that is based on prior research. Trained nurse peer reviewers carried out structured implicit review, which utilized their professional judgment to evaluate the process of nursing care for patients admitted to acute hospitals with heart failure or cerebrovascular accident. Findings show significant variations in the quality of nursing care and support the continued development of nursing quality assessment and improvement initiatives directed at reducing the gap between nursing theory and practice.

Agitation in the demented patient. A framework for management.

The inability to manage agitation has led to institutionalization of the patient by the family, overuse of physical restraints, and inappropriate use of psychotropic medication, all of which confound the behavior of the demented individual. It is not only the behavior of the patient but also the interpretation of that behavior that is critically important in the successful management of agitation. Caregivers must be careful to assess their own reactions and responses to patient behaviors before actions are taken that may not lessen agitation but increase the frequency and intensity of patient action.

Acculturation, socioeconomic vulnerability, and quality of life in Spanish-speaking and bilingual latino HIV-infected men and women.

Little is known about the health-related QOL (HRQOL) of low-income, Latino men and women living with HIV. Monolingual Spanish-speaking Latino individuals may be at greater risk than bilingual men and women for poor HRQOL due to problems associated with language and cultural barriers. This study examined the health status and HRQOL of these two groups of clinic patients. The monolingual group had significantly lower levels of acculturation but did not differ from the bilingual group on any dimension of health status. This group also reported more disruptions on several dimensions of HRQOL. In a multivariate context, health status variables (as a block) accounted for the greatest proportion of variance in all three measures of HRQOL. The results did not support the hypothesis that acculturation mediates the impact of health status on HRQOL. More studies are needed to examine the impact of acculturation and socioeconomic vulnerability on health outcomes.

Determining Care Management Activities Associated with Mastery and Relationship Strain for Dementia Caregivers

OBJECTIVES: To identify specific care management activities within a dementia care management intervention that are associated with 18‐month change in caregiver mastery and relationship strain.

Use of Protocols and Guidelines by Telephone Nurses

Changes in health care delivery, specifically the addition of telephone advice, affect how nurses work and how patients perceive care. It is important to understand the resources available to these nurses, the process by which they provide care, and patient outcomes. This descriptive study describes one type of resource, the availability and use of protocols. It also describes relationships between protocols and the quality of the nursing process and patient outcomes. Two-hundred-three taped calls to 32 advice RNs and 156 patient follow-up calls were used to measure protocol usage, nursing process quality, and patient outcomes. Although protocols were available for 78.8% of the calls, nurses varied in their extent of use (63.9% not fully used). There was a negative relationship (r = −0.395, p < 0.000) between the availability of protocols and overall quality of the nursing process. Protocol availability and use did not affect patient outcomes.