Carol M. Musil

A comparison of imputation techniques for handling missing data.

Researchers are commonly faced with the problem of missing data. This article presents theoretical and empirical information for the selection and application of approaches for handling missing data on a single variable. An actual data set of 492 cases with no missing values was used to create a simulated yet realistic data set with missing at random (MAR) data. The authors compare and contrast five approaches (listwise deletion, mean substitution, simple regression, regression with an error term, and the expectation maximization [EM] algorithm) for dealing with missing data, and compare the effects of each method on descriptive statistics and correlation coefficients for the imputed data (n = 96) and the entire sample (n = 492) when imputed data are included. All methods had limitations, although our findings suggest that mean substitution was the least effective and that regression with an error term and the EM algorithm produced estimates closest to those of the original variables.

Health of grandmothers: a comparison by caregiver status.

Objectives:In this cross-sectional study, stress, coping, social support, and health were compared in 86 primary caregiver grandmothers, 85 partial/supplemental caregiver grandmothers in multigenerational homes, and 112 noncaregiver grandmothers. Whether support and coping reduced effects of stress on the physical and mental health of grandmother caregivers, including mediating and moderating effects, was examined. Methods:A convenience sample completed a mailed questionnaire that included measures of stress, health, support, and coping. Results:Primary caregivers reported worse self-assessed health, but partial/supplemental caregivers reported a tendency toward more depression and more instrumental support. Noncaregivers reported the least stress and less active and avoidant coping. Coping and subjective support added to the variance of depression and self-rated health. Subjective support and avoidant coping mediated between stress and health, and active coping moderated the effects of stress on health. Discussion:Implications of these findings relative to the health of grandmothers by caregiver status are discussed.

Structural equation modeling and its relationship to multiple regression and factor analysis

Using a conceptual and nontechnical approach, the meaning of structural equation modeling (SEM) and the similarities to, and differences from, more commonly used procedures such as correlation, regression, path analysis, and factor analysis are explained. Application of the statistical technique is presented using data from a study of the relationships among stresses, strains, and physical health in a random sample of 492 community-dwelling elders aged 65 and older. Advantages of each statistical procedure are described. Theoretical issues related to the use of each procedure are presented with emphasis on the need for a sound theoretical model and match between the statistical procedure and the aims of the analysis.

Relationships among self-care agency, self-efficacy, self-care, and glycemic control.

Costly complications of diabetes often arise from poor glycemic control. Appropriate diabetes self-care management may improve control. This study examined whether self-care management affects glycemic control and mediates relationships between self-efficacy and self-care agency with glycemic control. In a cross-sectional correlational design, data from a prior study of 141 insulin-requiring adults with type 1 or type 2 diabetes were examined using descriptive statistics, Pearsons correlation, and multiple hierarchical regression. Findings indicated that greater self-care agency and self-efficacy lead to greater self-care management, in turn leading to better glycemic control. Self-care management did not mediate between self-efficacy or self-care agency and glycemic control. Thus, beliefs or capabilities for self-care are insufficient to improve glycemic control; doing so requires self-care management.

The influence of uncertainty in illness, stress appraisal, and hope on coping in survivors of breast cancer.

On the basis of Mishel’s uncertainty in illness theory, Lazarus and Folkman’s stress on appraisal and coping, and Herth’s perspective of hope, this cross-sectional, correlational study was designed to examine the influence of uncertainty, stress appraisal, and hope on coping in 71 survivors of breast cancer. Uncertainty was measured by the Mishel Uncertainty in Illness: Community Scale, stress appraisal by the Stress Appraisal Index, hope by the Herth Hope Index, and coping by the Ways of Coping Questionnaires (WCQ).

Grandmothers and Caregiving to Grandchildren: Continuity, Change, and Outcomes Over 24 Months

PURPOSE Transitions in caregiving, such as becoming a primary caregiver to grandchildren or having adult children and grandchildren move in or out, may affect the well-being of the grandmother. DESIGN AND METHODS This report describes caregiving patterns at 3 time points over 24 months in a sample of 485 Ohio grandmothers and examines the effects of stability and change in grandmother caregiving roles (raising a grandchild, living in a multigenerational home, or not caregiving to grandchildren). Drawing on the Resiliency Model of Family Stress, the study examined caregiving stress and reward, intrafamily strain, social support, resourcefulness, depressive symptoms, mental and physical health, and perceived family functioning. Caregiver group, time of measurement, switching between caregiver groups, and baseline age, race, education, work status, and marital status were considered as independent variables within the context of a one-way treatment structure in a mixed-model multivariate analysis. RESULTS There were significant caregiver group effects for all variables, except mental health and resourcefulness. Grandmothers raising grandchildren reported the most stress, intrafamily strain, and perceived problems in family functioning, the worst physical health and more depressive symptoms, and the least reward and subjective support. Across groups, there were significant time effects, with worsening physical health and increased stress over time. Switching to higher levels of caregiving was associated with worsening physical health and increases in stress, intrafamily strain, and perceived problems in family functioning. IMPLICATIONS Recommendations for research and for practice, especially during times of caregiving transition or for grandmothers raising grandchildren, are discussed.

Testing a conceptual framework for diabetes self-care management.

Diabetes is a major source of morbidity, mortality, and economic expense in the United States. The majority of researchers and clinicians believe that diabetes is a self-care management disease, and that patients should be reliable, capable, and sufficiently responsible to take care of themselves. However, individuals with diabetes may or may not have diabetes knowledge, social support, self-care agency (an individual’s capability to perform self-care actions), and self-efficacy (an individual’s beliefs in his or her capability to perform self-care actions) that would help them to engage in diabetes self-care management. Therefore, this study examined the relationship among those factors using a cross-sectional model testing design. A convenient sample of 141 insulin-requiring individuals with either diabetes type 1 or type 2, 21 years old and over, was recruited from an outpatient diabetes care center located in a Southeast region of the United States. Simple linear regression, multiple standard regression, and multiple hierarchical regression were used to analyze the data. Individuals with greater diabetes knowledge had greater self-care agency and self-efficacy. Those with a higher score in social support had greater self-care agency and better diabetes self-care management, and those with greater self-efficacy had better diabetes self-care management. In addition, self-care agency mediated the effects of diabetes knowledge on self-efficacy and the effects of social support on diabetes self-care management. Self-efficacy mediated the effects of self-care agency on diabetes self-care management. Furthermore, the linear combination of diabetes knowledge, social support, self-care agency, and self-efficacy, taken together, positively affected diabetes self-care management. Enhancing an individual’s diabetes knowledge, social support, self-care agency, and self-efficacy may be a strategy which can promote better engagement in diabetes self-care.

Families With Children Who Are Technology-Dependent: Normalization and Family Functioning

This cross-sectional study examined family functioning and normalization in 103 mothers of children ≤16 years of age dependent on medical technology (mechanical ventilation, intravenous nutrition/medication, respiratory/nutritional support) following initiation of home care. Differences in outcomes (mother’s depressive symptoms, normalization, family functioning), based on the type of technology used, were also examined. Participants were interviewed face-to-face using the Demographic Characteristics Questionnaire, the Functional Status II–Revised Scale, the Center for Epidemiological Studies–Depression Scale, a Normalization Scale subscale, and the Feetham Family Functioning Survey. Thirty-five percent of the variance in family functioning was explained primarily by the mothers’ level of depressive symptoms. Several variables were significant predictors of normalization. Analysis of variance revealed no significant difference in outcomes based on the type of technology used. Mothers of technology-dependent children are at high risk for clinical depression that may affect family functioning. This article concludes with clinical practice and policy implications.

RELATIONSHIPS OF FAMILY FUNCTIONING, SELF-ESTEEM, AND RESOURCEFUL COPING OF THAI ADOLESCENTS WITH ASTHMA

Within the context of Rosenbaums theory of learned resourcefulness, this correlational study examined the relationships among family functioning, self-esteem, and resourceful coping in Thai adolescents with asthma. A convenience sample of 132 Thai adolescents (aged 12–17 years) with asthma was recruited from the outpatient asthma clinics of four hospitals in Bangkok. Self-administered questionnaires included an assessment of demographic information and asthma status, the revised Family APGAR, the Rosenberg Self-Esteem Scale, and the Childrens Self-Control Scale. Hierarchical multiple regression analysis was used to examine the relationships among variables. Effective family functioning had a significant positive effect on self-esteem (β = .27, p < .01) and resourceful coping (β = .30, p < .01), controlling for gender and age. However, self-esteem was not significantly correlated with resourceful coping (β = .15, p = .08). The findings suggest that nursing interventions should take into account the role of family functioning in promoting self-esteem and resourceful coping in Thai adolescents with asthma. Recommendations for future research include replication of the study with a larger sample of adolescents with asthma and with adolescents with other chronic illnesses.

Critical thinking of nurse managers related to staff RNs' perceptions of the practice environment.

Background Information and Significance: Critical thinking (CT) skills and the inclination to engage in critical thinking are essential for nurse managers to function as transformational leaders capable of influencing staff to align with organizational goals. In an extensive literature review, numerous studies were found examining the concept of CT in students and no studies were found exploring CT in nurse managers. Identifying the attributes, such as CT, that lead to success in the nurse manager role is useful when preparing nurse managers to lead effectively in the current healthcare climate. Research Question: Is there a difference between nurse managers’ CT dispositions and their respective staff nurses’ perceptions of the practice environment? Design: A convenience sample of 12 nurse managers and a random sample of 132 of their respective staff registered nurses (RNs) participated in this descriptive study. CT in nurse managers was measured by the California Critical Thinking Disposition Inventory (CCTDI). Staff RNs’ perceptions of the practice environment were measured by the Practice Environment Scale (PES). The research question was answered using a t test. Findings: Significant (p < .001) differences were found between specific nurse managers’ CCTDI scores for open-mindedness, analyticity, and critical thinking confidence, and significant differences (p < .01) were found for systematicity when compared with their respective staff RNs’ mean subscale and overall PES scores. Conclusions: Results of the study support the positive relationship between strength in critical thinking dispositions of nurse managers and their respective staff RNs’ perceptions of the practice environment. Nurse managers with stronger CT dispositions may be better able to create positive practice environments that are conducive to job satisfaction and thus the retention of staff RNs. Inclusion of strategies to support the development and use of CT in nurse managers is recommended. CT and other leadership attributes and skills including emotional and social intelligence and management of change through an appreciative inquiry process may provide opportunities to improve leadership effectiveness in nurse managers. Clinical Relevance: Enhancing critical thinking skills and dispositions of nurse managers may help to create positive work environments for staff RNs. Staff RNs who work in an environment perceived to be positive may be in a better position to deliver high quality, safe patient care.