Colleen Delaney

The Spirituality Scale Development and Psychometric Testing of a Holistic Instrument to Assess the Human Spiritual Dimension

Purpose: The purpose of this study was to develop, refine, and evaluate the psychometric characteristics of the Spirituality Scale (SS). The SS is a holistic instrument that attempts to measure the beliefs, intuitions, lifestyle choices, practices, and rituals representative of the human spiritual dimension and is designed to guide spiritual interventions. Method: A researcher-developed instrument was designed to assess spirituality from a holistic perspective. Items were generated to measure four conceptualized domains of spirituality. The SS was completed by 240 adults with chronic illness. Findings: Psychometric analysis of the SS provided strong evidence of the reliability and validity of the instrument. Three factors of spirituality that supported the theoretical framework were identified: Self-Discovery, Relationships, and Eco-Awareness. Implications: These findings can assist in facilitating the inclusion of spirituality in health care and have the potential to provide a transforming vision for nursing care and a vehicle to evoking optimal patient outcomes.

Pilot testing of a multicomponent home care intervention for older adults with heart failure: an academic clinical partnership.

Background: Heart failure (HF) has clinically significant psychological and physical consequences for older persons, and hospitalization for HF is frequent and costly to the Medicare program. As HF is the most common primary Medicare home care diagnosis, there is a critical need to develop home care services that improve heath-related outcomes for this population. The primary aim of this pilot study was to develop, implement, and test the initial feasibility and potential efficacy of the Home-Care Education, Assessment, Remote-Monitoring, and Therapeutic Activities (HEART) trial, a nurse-directed multicomponent home care intervention. Observed outcomes were quality of life (QOL), depressive symptoms, and 90-day hospitalization. Methods: Twenty-four patients with a primary diagnosis of HF were assigned to the intervention (n = 12) or control group (n = 12) according to geographical location in a large multibranch Medicare-certified home health agency. Intervention group patients received 8 structured nurse education visits using evidence-based protocols designed in previous trials to teach HF self-management and to prevent/reduce depression, as well as a telemonitoring system. Control group patients received usual care and telemonitoring. Quality of life was assessed using the Minnesota Living With Heart Failure questionnaire. Depressive symptoms were assed using the Patient Health Questionnaire 9 at baseline and 90-day study end point. Results: Study protocols and instrumentation were found to be feasible and effective. Examination of enrollment data led to a reevaluation of eligibility criteria. Patients participating in the HEART intervention demonstrated significantly improved QOL (F = 8.99, P = .007) and significantly reduced depressive symptoms (F = 35.10, P = .001) in comparison to control group patients at the study end point. There was a trend toward lower hospital readmission rates in the intervention group (16% vs 25%), but this was not statistically significant. Conclusion: This pilot study suggests that a full-scale trial of the HEART intervention is feasible.

The Influence of a Spirituality-Based Intervention on Quality of Life, Depression, and Anxiety in Community-Dwelling Adults With Cardiovascular Disease A Pilot Study

Purpose and Design: The specific aims of this pre-experimental pilot study were to determine the feasibility and preliminary efficacy of an individualized spirituality-based intervention on health-related outcomes (quality-of-life [QOL], depression, and anxiety) in community-dwelling patients with cardiovascular disease (CVD). Methods: Self-reported QOL, depression, and anxiety data were provided by cardiac patients recruited from three community-based organizations, ( N = 27) at baseline and one month later. The Spirituality Scale developed by the principal investigator assessed study participants’ level of spirituality and scoring on the subscales activated one or more of three spirituality-based interventions. Repeated measures analysis of variance was used to evaluate temporal changes. Findings: Patients who participated in the 1-month intervention demonstrated a significant modest increase in overall QOL. There was a trend toward lower depression scores but this was not significant. No significant changes were seen in anxiety scores. Content analysis of patients’ perceptions of feasibility supports the acceptability of the intervention. Conclusion: Results from this small pilot study provide preliminary evidence that the individualized spirituality-based intervention used in this study holds promise as an addition to traditional cardiac care and has the potential to improve QOL in community-dwelling adults with CVD.

Blessings: the influence of a spirituality-based intervention on psychospiritual outcomes in a cardiac population.

Cardiovascular disease affects an individuals body, mind, and spirit. The multidimensional impact of heart disease requires holistic care that includes the spiritual dimension for patients to achieve optimal healing and recovery. This pretest, posttest repeated-measures quasi-experimental study sought to examine the influence of a spiritual intervention on psychospiritual outcomes in a cardiac population.

Health Care Implications and Space Allocation of Research Published in Nursing Journals

PURPOSE To examine how research is disseminated through nursing journals and to examine characteristics of published research. DESIGN A cross-sectional descriptive survey was conducted with manuscripts from 78 nursing journals that publish research. METHOD The final issue for 1999 was examined. Pairs of independent raters content-analyzed all research manuscripts. DISCUSSION Research studies comprised 241 (42.9%) of the manuscripts and 51.4% of the journal space. Many empirical studies omitted validity and reliability. Few manuscripts reported the date for completion of data collection, and fewer than one third contained the length of time from acceptance to publication. CONCLUSIONS Enhanced instrumentation reporting, shorter time from data collection to publication, and an increase in journal space devoted to research might enable nurses to make more cutting-edge clinical decisions.

Results and Lessons Learned from a Nurse Practitioner-Guided Dementia Care Intervention for Primary Care Patients and Their Family Caregivers

Older adults with dementia care needs often visit primary care physicians (PCPs), but PCP dementia care limitations are widely documented. This study tested the value of employing a nurse practitioner (NP) with geropsychiatric expertise to augment PCP care for newly and recently diagnosed patients and family caregivers. Twenty-one dyads received the NP intervention; 10 dyads were controls. Outcomes included patient neuropsychiatric symptom and quality of life changes, and caregiver depression, burden, and self-efficacy changes. Intervention acceptability by patients, caregivers, and PCPs was determined. No outcome differences were found; however, the NP intervention was deemed highly satisfactory by all stakeholders. Patients experienced no significant cognitive decline during the 12-month study period, helping explain why outcomes did not change. Given widespread acceptability, future tests of this PCP-enhancing intervention should include patients with more progressive cognitive decline at study entry. NPs with geropsychiatric expertise are ideal interventionists for this rapidly growing target population.

A Randomized Trial of Telemonitoring and Self-Care Education in Heart Failure Patients Following Home Care Discharge

Patients with heart failure (HF) who have been discharged from a home care agency are a particularly vulnerable group at risk for poor outcomes and high rehositalization rates. The primary aim of this experimental study was to determine the efficacy of a telemonitoring and self-care education intervention in reducing hospitalization and improving quality of life and patient’s knowledge of HF after home care discharge. Ninety-three participants completed the study. The primary outcome of 90-day post–home care discharge hospitalization was significantly reduced in the intervention group compared to controls (9 vs. 18, p - .046). HF knowledge (p = .013) and QOL (p = .004) were significantly increased in intervention group patients in comparison to control group patients’ at the study endpoint.

Depression Screening and Interventions for Older Home Health Care Patients Program Design and Training Outcomes for a Train-the-Trainer Model

The increasing prevalence of depression in elderly home health care patients led to a statewide initiative in Connecticut to enhance evidence-based depression treatment for older adults. A training curriculum on depression screening and interventions was developed and disseminated to 25 home care professionals representing 14 agencies in Connecticut using a train-the-trainer model. Home care trainers included nurses and social workers. This article describes Phase I curriculum design and initial evaluation of the impact of the training on the preparation of trainers to provide depression care education at their home care agencies. Several evaluation measures, including an appraisal of the self-reported attitudes and self-efficacy of home care professionals towards depressed older adults, a pre/post-test to assess the trainers’ knowledge, and willingness of trainers to implement the education program at their agencies were used to assess program outcomes. Participants’ self-efficacy levels in screening and caring for depressed older adults was significantly increased following the education program compared to immediately before the education program (t, (24) = -4.204; p < .001).

Advanced practice nursing students' knowledge, self-efficacy, and attitudes related to depression in older adults: teaching holistic depression care.

The aim of this study was to examine the knowledge, attitudes, and self-efficacy of advanced practice nursing students toward depression in older adults. Findings suggest that advanced practice nursing students are interested in caring for the whole person and desired more information on the physical and emotional-spiritual needs of older patients with depression. Suggestions for holistic nursing depression care education are presented.

Pilot Study of a Statewide Initiative to Enhance Depression Care Among Older Home Care Patients

Late-life depression is prevalent in home care. This pilot study, part of a statewide initiative to enhance depression care, evaluated the influence of a 2-hour depression screening and intervention workshop on home care professionals’ knowledge, self-efficacy, and attitudes related to depression in older home care patients. A pretest, posttest design was used to evaluate the effects of the workshop with 280 home care professionals from 7 home care agencies. Following the depression workshop, participants’ knowledge levels in evidence-based screening and care for depressed older adults was significantly increased, t(280) = 16.49, p<.001. A significant increase in confidence and attitude ratings were found (p<.001). Findings from this pilot study support broader dissemination throughout Connecticut home care agencies.