Diana L. Morris

Effects of teaching resourcefulness skills to elders

The objective of this study was to examine the effects of learned resourcefulness training (LRT) on health of elders in retirement communities (RCs). In a clinical trial, 46 elders in four randomly selected RCs received resourcefulness training and were compared to 43 elders in four RCs who participated in a focused reflection reminiscence (FRR) group. The two groups were similar at baseline. Repeated measures analysis of variance revealed no changes on anxiety or depression over time; however, both were significantly correlated with functional status (rs = 0.29 and 0.35, ps < 0.01), self-assessed health (rs = −0.18 and −0.26, ps < 0.05), and resourcefulness (rs = −0.24 and −0.21, ps < 0.05). Although main effects for group were not significant, interaction effects of group and time on self-assessed health and functional status were found. These findings suggest that although teaching resourcefulness to groups of elders in RCs may have beneficial effects on improving their perception of health and functioning over time, significant effects on mental health may not be apparent.

Resourcefulness and self-care in pregnant women with HIV.

The human immunodeficiency virus (HIV) has caused suffering in the lives of humans worldwide. Pregnant Thai women now constitute the fastest-growing segment of individuals diagnosed with HIV∕AIDS. Few studies have looked at self-care or resourcefulness among pregnant women with HIV. Using Rosenbaum’s theory of learned resourcefulness, this study examined the direct effects of depression and resourcefulness on prenatal self-care as well as the mediating effects of resourcefulness on depression and self-care. A model testing study with 153 pregnant Thai women compared the effects of depression and resourcefulness on prenatal self-care in HIV-positive and HIV-negative groups. Regression analyses indicated direct effects of depression and resourcefulness on prenatal self-care. The effect of depression on prenatal self-care was mediated by resourcefulness. HIV status did not predict prenatal self-care. The findings on the relationships of depression, resourcefulness, and prenatal self-care can help nurses provide effective services to pregnant Thai women, including counseling on self-care.

Focused Reflection Reminiscence Group for Elders: Implementation and Evaluation

The majority of elders have at least one or more chronic conditions. Functional decline coupled with increased dependence can make elders more vulnerable to negative emotions. Reminiscence can be useful in maintaining a healthy psychological adaptation in the later years of life. This study examined the effectiveness of a specific type of reminiscence in reducing negative emotions in 32 elders residing in retirement communities. This type of reminiscence, called focused reflection, was organized into six weekly, 2-hour group sessions, each with a specific theme. Paired t tests suggested that the focused reflection program reduced symptoms of depression and anxiety but not those reflecting agitation. Overall, the participants gave high ratings to the program. Health care providers should develop focused reflection reminiscence programs to enhance the psychological well-being of elders. Further testing of the focused reflection in larger groups of elders is recommended.

Health problems and health actions among community-dwelling older adults: results of a health diary study

This study examined the health problems and health actions reported by a sample of older adults (N = 60) who maintained health diaries over a 4-week period. The diary sample was 78% (n = 47) White; 52% (n = 31) were women, with a mean age of 75 years (SD = 5.3). Content analysis was used to examine the types of health problems reported in the diaries, which health problems were likely to be considered an illness, and what health actions were reported. Respondents reported an average of four different types of health problems over the 4-week diary period. There were differences in symptom reports related to gender, age, or race. The most frequently reported health problems were musculoskeletal problems (n = 38), runny nose and respiratory problems (n = 24), gastrointestinal problems (n = 22), and headaches (n = 22). Only 36% of all health problems were considered to be illnesses. Subjects recorded a number of health actions in response to their health complaints, including over-the-counter (OTC) medication use (83%), prescription medication use (53%), self-care activities (72%), and professional consultation (43%). Specific strategies that subjects used to deal with various health problems, implications of the findings, and the usefulness of health diaries as a clinical tool are discussed.

Recurrent symptoms: well-being and management.

Although most older adults report one or more symptoms of a chronic health problem, little attention has been paid to the report of these symptoms over time and whether different symptom patterns affect well-being and symptom management in community-dwelling elders. Therefore, this study examined whether community-dwelling older adults in Ohio, U.S.A. who experience consistently recurring (a) arthritis or (b) cardiopulmonary symptoms report more depression and worse self-assessed health and show more symptom management than those who report inconsistent symptoms and if there are differences in well-being and symptom management over time. This secondary analysis used longitudinal data collected from a random sample of 387 older adults who reported their health complaints in four interviews over 27 months time. Subjects were included in this analysis if they reported either arthritis (n = 321) or cardiopulmonary (n = 232) symptoms at one or more times during 27 months, and then were classified as having either consistent (occurring at all four time points) or intermittent/inconsistent (occurring at three or fewer time points) symptoms. Data analysis included t-tests, chi-square tests, and Repeated Measures ANOVA. Results indicate that those with consistent symptoms reported greater depression and worse self-assessed health than those with less consistent symptoms. Specifically, those with consistent cardiopulmonary symptoms became more depressed over time. Those with consistent cardiopulmonary complaints were more likely than those with an inconsistent pattern to use an illness label to describe their symptoms. Those with consistent arthritis symptoms tended to use more self-care at all time points, to label their symptoms as an illness, and were more likely to consult a physician as their symptoms persisted. The implications of symptom recurrence on well-being, symptom management and the concept chronicity are discussed.

Elderly Persons' Interpretation of a Bodily Change as an Illness Symptom:

Based on a community random sample of 406 elderly, factors that persuade an elderly person to interpret a bodily change as a symptom of illness are described. Three measures of such illness interpretation among 27 different bodily changes are used in analysis: giving an illness label to the change, consulting a physician for it, and/or using self-care for treatment. The three types of representations across all 27 bodily changes taken together, as well as among five typical complaints most commonly experienced, are reported. The findings show that the perceived seriousness of the bodily change and the general health context of the older person in which it has occurred are conducive to interpreting a bodily change as an illness symptom.

Benefits of a Poetry Writing Intervention for Family Caregivers of Elders with Dementia

This pilot clinical trial tested effectiveness of a poetry writing intervention for family caregivers of elders with dementia. This paper presents findings from a larger study using mixed methods to examine outcome variables of self-transcendence, resilience, depressive symptoms, and subjective caregiver burden. Findings reported here focus on qualitative analysis of in-depth interviews conducted with participants following their poetry writing experience. A grounded theory approach was used. Themes that arose from the data support a mid-range Theory of Self-Affirmation in Caregivers with subthemes of achievement, catharsis, greater acceptance, empathy, self-awareness, reflection, creative and fun, positive challenge, and helping others.

Geropsychiatric Nursing Education: Challenge and Opportunity:

With the emergence of the mental health needs of older adults as a foremost public health concern of the 21st century, the melding of gerontological and psychiatric expertise among frontline health care providers assumes unprecedented urgency. Undergraduate and graduate educational preparation and continuing education learning strategies to develop and support a geropsychiatric nurse workforce will be critical to enhancing the quality of lives of millions of older persons. Opportunities abound for creativity in curriculum development accompanied by systematic evaluation of workforce outcomes and dissemination of successful educational models. Attention to these needs will facilitate long-stymied efforts to achieve advanced practice certification in geropsychiatric nursing.

Need for Resourcefulness Training for Women Caregivers of Elders with Dementia

Nearly ten million American women are caregivers of elders with dementia and may experience overwhelming stress that adversely affects their mental health. Interventions to teach them resourcefulness skills for managing stress can promote optimal mental health and facilitate continued caregiving. However, effectiveness of resourcefulness training (RT) cannot be examined until its need is established. This pilot trial with 138 women caregivers of someone with dementia examined the need for RT using subjective and objective data. Data were collected before and after RT. Data analysis focused on baseline resourcefulness scores (higher scores = lower need); scores in relation to attrition; correlations among resourcefulness, stress, and depressive symptoms; and post-RT evaluation of the need for RT. Baseline resourcefulness scores were normally distributed and showed that 74% of the caregivers had a moderate to high need for RT. Reasons for attrition were unrelated to the need for RT; however, caregivers who dropped out had resourcefulness scores that averaged two points higher than those who remained in the study. Lower resourcefulness was associated greater stress (r = –.37, p < .001) and depressive symptoms (r = –.52, p < .001). Of the 63 caregivers who received RT, 82% (n = 52) reported a felt need for RT and 94% (n = 59) believed that other caregivers need RT. The results suggest a substantial need for resourcefulness training in women dementia caregivers and support moving forward to test RTs effectiveness for reducing caregiver stress and depressive symptoms.

Social Determinants of Adolescent Depression: An Examination of Racial Differences

Conventional behavior theories that assert adolescent risk behaviors are determined by peer and parental relationships are being challenged as research begins to consider broader socioenvironmental factors. This study, using data from the Longitudinal Study for Adolescent Health (Add Health), Wave II, Public Use Data, and the Social Determinants of Adolescent Risk Behaviors (SDOARB) framework, examines relationships among socioeconomic status (SES), academic performance, perceived peer prejudice, and perceived teacher discrimination as predictors of depressive symptoms among high school adolescents. Overall, the study found that GPA was a significant predictor of depressive symptoms across all three racial groups (Black, White, and Other Minority). Teacher discrimination predicted depressive symptoms among White and Other minority adolescents, but not Black adolescents. These findings suggest the need for interventions within schools for both students and teachers around racial differences in perceptions of prejudice and discrimination. Failure to address overt and covert subtleties of discrimination and prejudice within schools and policies which affect these interpersonal dynamics may have a significant impact on the overall mental wellbeing of adolescents.