Jaclene A. Zauszniewski

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.

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.

Sensation and Distress of Pain Scales: reliability, validity, and sensitivity.

Psychometric properties of the Sensation and Distress of Pain Visual Analogue Scales (VAS) are compared to dual numerical rating scales (NRS) with data from a randomized controlled trial of postoperative patients. On postoperative days 1 and 2, 15-minute test-retest reliability was .73 to .82 for the VAS and slightly lower for the NRS, r = .72 to .78, while convergent validity of the scales ranged from r = .90 to .92; construct validity of sensation and distress ranged from r = .72 to .85; and discriminant validity was lower, r - .65 to .78. Both instruments were significantly associated with pain reduction following treatment, p < .05 to .01. The VAS scores were significantly lower, p < .01 to .001, and more evenly distributed than NRS scores. It is recommended that the VAS be used in research to produce continuous scores that are more suited to parametric analysis.

The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial

OBJECTIVES To examine effects of sedative music on cancer pain. DESIGN A randomized controlled trial. SETTINGS Two large medical centers in Kaoshiung City, in southern Taiwan. PARTICIPANTS 126 hospitalized persons with cancer pain. METHODS Participants were randomly assigned to an experimental (n=62) or a control group (n=64), with computerized minimization, stratifying on gender, pain, and hospital unit. Music choices included folk songs, Buddhist hymns (Taiwanese music), plus harp, and piano (American). The experimental group listened to music for 30 min; the control group rested in bed. Sensation and distress of pain were rated on 100mm VAS before and after the 30-min test. RESULTS Using MANCOVA, there was significantly less posttest pain in the music versus the control group, p<.001. Effect sizes were large, Cohens d=.64, sensation, d=.70, distress, indicating that music was very helpful for pain. Thirty minutes of music provided 50% relief in 42% of the music group compared to 8% of the controls. The number needed to treat (NNT) to find one with 50% sensation relief was three patients. More patients chose Taiwanese music (71%) than American music (29%), but both were liked and effective. CONCLUSIONS Offering a choice of familiar, culturally appropriate music was a key element of the intervention. Findings extend the Good and Moore theory (1996) to cancer pain. Soft music was safe, effective, and liked by participants. It provided greater relief of cancer pain than analgesics alone. Thus nurses should offer calming, familiar music to supplement analgesic medication for persons with cancer pain.

LIFE EVENTS AND PSYCHOLOGICAL WELL-BEING IN WOMEN SENTENCED TO PRISON

There have been no systematic analyses of the factors that influence the development of psychological well-being in women sentenced to prison. This study identified relationships among life events, coping resources, and psychological well-being (indicated by the absence of anxiety and depression). A descriptive correlational design was used in a convenience sample of 62 incarcerated female offenders. The respondents were in their early 30s, single, unemployed, and receiving financial support from a variety of sources. They reported an average of 10 life events in the 12 months preceding incarceration and accumulated an average of 354 life change units. A positive correlation between the number of life events and depression was identified (r = .24, p < .05). The women in this study had high levels of depression as measured by the Center for Epidemiologic Studies Depression Scale (L. Radloff, 1977; M = 31) and anxiety as measured by the State-Trait Anxiety Inventory (C. D. Spielberger, 1983; M = 46). Nursing interventions to reduce psychological distress at the time of admission to a correctional facility may reduce feelings of loss, inadequacy, and powerlessness that the women might otherwise have to endure.

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.

Development and Testing of the Resourcefulness Scale for Older Adults

Resourcefulness is the ability to independently perform daily tasks (personal resourcefulness) and to seek help from others when unable to function independently (social resourcefulness). The 2 forms of resourcefulness are theoretically related, yet no current measure captures both simultaneously. This 2-phase study involved development and testing of a Resourcefulness Scale for elders from existing measures of personal and social resourcefulness. Data from 2 studies of 451 chronically ill elders were randomly split: the measure was developed in phase 1 and validated in phase 2. The new Resourcefulness Scale has acceptable internal consistency (α = .85). Two correlated subscales reflecting personal and social resourcefulness (r = .41) were confirmed. The Resourcefulness Scale has potential usefulness for older adults as well as younger and middle-aged adults.

Resilience in Family Members of Persons with Autism Spectrum Disorder: A Review of the Literature

Worldwide, caregivers find caring for children with Autism Spectrum Disorder (ASD) challenging. Family members must manage many aspects of care giving, which is demanding, overwhelming, and can affect the family members’ mental health. However learning how to be resilient may help family members overcome the stress and burden associated with caring for a person with ASD. A search was completed in Medline, PsycINFO, Proquest, Web of Science, and CINAHL using the key words “autism,” “caregivers,” “mothers,” and “fathers,” alone and in combination. Inclusion criteria were English language articles reporting studies with samples of children with ASD, as distinct from children with other intellectual or developmental disabilities. Fifty-eight articles that met these inclusion criteria were summarized and, from those, the authors selected 22 articles that included indicators of resilience. This integrative review highlights current research on resilience in adult family members of persons with ASD. Indicators of resilience, risk factors, protective factors, and outcomes of resilience were identified. The review indicates that parents of children with ASD who possess indicators of resilience are better able to manage the adversity associated with caring for children with ASD. Thus, enhancing resilience among family members of persons with autism may be beneficial to both the caregivers and care recipients.

Milieu Change and Relocation Adjustment in Elders

Relocation is a major life event for elders and has been found to adversely affect their adjustment and ability to perform daily activities. Rosenbaums theory of learned resourcefulness suggests that such adverse effects can be minimized if elders have positive cognitions and are resourceful. A cross-sectional design was used to examine the hypothesized relationships among the study variables in a sample of 104 cognitively unimpaired elders (aged 65+ years) who have relocated to retirement communities in Northeast Ohio. Results indicate that positive cognitions had a direct positive effect on learned resourcefulness and on relocation adjustment. Furthermore, learned resourcefulness had a moderating effect on the relationship between relocation controllability and relocation adjustment when controlling for covariates. It is imperative to generate interventions to enhance positive thinking and learned resourcefulness for elders facing the need to relocate and to create the therapeutic milieu within the retirement communities.

Development and testing of a measure of depressive cognitions in older adults.

Assessment of cognitive processes that predispose or contribute to clinical depression in elders is important for planning interventions that facilitate positive cognitive appraisal and effective coping strategies. Instruments evaluating severity of depression exist; however, none measure specific depressive cognitions. This paper describes the development and pilot testing of the Depressive Cognitions Scale (DCS) for older adults. Derived from Erikson’s Psychosocial Theory, the 8 items comprising the scale were selected by clinical experts from a pool of 24 items. Each item reflects a depressive cognition that may arise from less than successful resolution of one of Erikson’s developmental phases. Psychometric testing of the DCS was conducted with 60 functionally independent, community dwelling older adults (age 65+). An alpha of .78 indicated acceptable internal consistency. Construct validity was demonstrated by significant correlation with measures of psychosocial development. Further psychometric study of the DCS is recommended.