Betty Wehtje Winslow

Development of a Caregiver Empowerment Model to Promote Positive Outcomes

Family members caring for aging parents experience both negative and positive outcomes from providing care. Theoretical explanations for negative outcomes have been developed. There is need for models that explain and predict positive outcomes. This article describes the evolution of the Caregiver Empowerment Model (CEM) to explain and predict positive outcomes of family caregiving. Although empirical findings support positive outcomes of family caregiving, less attention has been given to theoretical rationale for positive effects. The CEM predicts that, in the presence of filial values and certain background variables, caregiving demands are appraised as challenges instead of stressors. Appraising caregiving demands as a challenge, finding meaning, and using certain types of coping strategies are posited to be associated with growth and well-being. The CEM extends our understanding of the complexity of the caregiving experience, and can serve as a framework to guide in developing and testing theory-based interventions to promote positive outcomes.

Vulnerable Populations and Ultimate Responsibility

Who has the ultimate responsibility for the well-being of the most vulnerable among us? Florence Nightingale voiced this concern in her testimony before the Royal Commission of the English Parliament in 1857, when she asked: “What can be done about the inexorable connection between poverty, sickness and early death? In mitigating the suffering of the poor, which approaches deserve the most support? Should the emphasis be on charity? on modern technological solutions? on social change?” (Nightingale, 1859) It’s a question that comes to mind especially now in the midst of our economic recession. Many states are facing budget shortfalls that require them to balance their budgets either by raising taxes or cutting programs. Several have opted to cut programs rather than raise taxes. You might ask whether there is a pattern to the programs that are being cut most frequently. Too often the answer seems to be that governors and legislators favor cutting social and health programs for those groups who have the least power, status, and resources. In 1998, we referred to these groups as vulnerable populations in a model we developed for nursing research, practice, and education (Flaskerud & Winslow, 1998). Vulnerable populations were identified as social groups who have an increased susceptibility or higher than the national average risk for health-related problems (differential patterns of morbidity, mortality, and life expectancy) related to fewer resources. In this model, we proposed relationships among three constructs: resource availability, relative risk, and health status. In plain language, what does this model tell us? People who have resources (money, power, access to health care) are able to use those resources to decrease their exposure to risks and/or re-

Divergent Views of Placement Decision-Making: A Qualitative Case Study

The purpose of this qualitative case study is to describe the contrasting perspectives between a family caregiver and the caregivers professional provider in regards to the placement decision-making experience of the caregiver. A qualitative, descriptive, revelatory case study, using a grounded theory approach for data analysis, was conducted to identify and compare major themes drawn from interviews with the caregiver-professional dyad. The case is described on the basis of three interviews, two caregiver interviews (pre- and post-placement) and one health professional interview. The 77-year-old caregiver in this case was a wife caring for her 88-year-old husband who was diagnosed with Alzheimers disease. The health professional was a social worker who led the support group the caregiver attended. Separate and private interviews were conducted by the principal investigator with the caregiver and health professional. Analysis revealed 11 major emerging categories that were compared from the caregivers and professionals perspective. The perspectives of the family caregiver and the health professional had some elements that were congruent and some that were incongruent. Professionals may be unaware that they are not providing the kind of help that the situation requires. In particular, anticipatory guidance is needed before crisis events make placement immediately necessary. Further research is needed to identify what kind of conditions contribute to smoother decision-making processes and long-term care transitions for caregivers of relatives with dementia.

Researching in Collectivist Cultures: Reflections and Recommendations.

Commonalities are presented from the experiences of U.S. nurse researchers who conducted studies in India, Jordan, Aotearoa/New Zealand, and Trinidad and Tobago. While planning research, it is important to engage collaborators who are members of the culture to be studied to understand what are culturally appropriate aims and methods. It is also vital to observe cultural etiquette, especially while gaining entrée and collecting data. Issues related to data collection include timing it around local holidays and events, and adapting individualist methods for obtaining consent and data to be more respectful for those in a collectivist culture. Care must be taken to give back, to sharing findings, and insure sustainability for future research in the host culture. Based on these and other reflections, recommendations are offered to support investigators planning research in a culture that is not their own.

The Relationship Between Mutuality, Filial Piety, and Depression in Family Caregivers in China.

Purpose. Caregiving to parent stroke survivors in China is increasing and adult child–parent relationships are being challenged. The purpose of this study was to explore whether mutuality and filial piety have a protective role against caregiver depression. Design. A cross-sectional correlational study was conducted with a nonproportional quota sample of 126 caregivers. Surveys were conducted at hospitals or in homes using structured questionnaires: the 15-item Mutuality Scale, the 4-item Filial Attitude Scale, the 9-item Filial Behavior Scale, and the 10-item Center for Epidemiological Studies Depression Scale. Results. Higher mutuality and stronger filial attitudes were significantly associated with less caregiver depression after the covariates were controlled. Mutuality explained 5.5% (p < .01) and filial attitude explained 4.6% (p < .01) of the variance in caregiver depression. Conclusion. Mutuality and filial attitude may be protective factors against caregiver depression. Implications for Practice. Supportive strategies can be implemented to enhance mutuality and filial attitude.

Nurse Spiritual Care: Prevalence and Correlates:

Many nurses embrace spiritual care as integral to holistic care. Evidence documenting the frequency of spiritual care provided in acute care settings, however, is sparse and weak. For this cross-sectional, correlational study, data were collected from N = 554 tertiary care nurses using the Nurse Spiritual Care Therapeutics Scale (NSCTS) measuring their self-reported spiritual care with patients/family members over the last 72 to 80 hours at work. While the most frequently endorsed practices centered on presence, listening, and spiritual assessment, the overall NSCTS score remained modest (M = 37; SD = 12; possible range = 17-85). Several associations were found; 32.4% of the variance in frequency of spiritual care provision was explained by nurse perception that spiritual issues come up often in the work setting, high nurse spirituality score, not working in pediatrics, and having received education about spiritual care. Findings allow for benchmarking of nursing practices that have often been invisible.