Jane Marie Kirschling

Establishing partnerships with family caregivers. Local and cosmopolitan knowledge.

Families now provide most of the care received by older people in the United States. Proposed changes in the health care system will mean that families must take an even greater role in delivering health care. It is crucial that nurses practicing in a variety of settings be prepared to establish partnerships with family caregivers in order to attend to the long-term care needs of older people.

Measurement of spiritual well-being: a hospice caregiver sample.

This is a methodological study designed to assess the reliability and validity of Paloutzian and Ellisons (1982) Spiritual Well-being Scale. The scale was administered to 70 family members caring for a terminally ill relative. The 20 item measure yields three scores: spiritual well-being (overall score), existential well-being and religious well-being (overall score), existential well-being and religious well-being. The Cronbachs alpha coefficients were .95, .94, and .84 respectively. Construct validity of the measure is discussed in relation to Bradburns Affect Balance Scale, qualitative data obtained during the interviews and a review of relevant literature related to spiritual well-being. Evidence in support of construct validity of the Spiritual Well-being Scale is lacking.

Social support: the experience of hospice family caregivers.

The concepts of social support, reciprocity, cost, and conflict were examined through a methodological study that assessed the reliability and validity of Tildens (1986) Cost and Reciprocity Index (CRI). The CRI was modified for the face-to-face interviews with 70 family members who were caring for a terminally ill relative enrolled in a hospice program. Item analyses was undertaken with the four subscales because of qualitative comments, a desire to streamline administration of the measure and an overall drop in the alpha coefficients compared with those previously reported. Based on this work 25 items were retained in the four subscales, 13 were eliminated. Cronbachs alpha coefficients and the average inter-item correlation for the revised subscales are reported. Correlation analysis of the revised subscales was also undertaken in order to explore the relationship among the subscales and with time since the care receivers diagnosis.

Assessing Grief Among the Bereaved Elderly: A Review of Existing Measures

The assessment of grief in the elderly, bereaved population has received much attention in the research and clinical literature. Existing instruments vary widely in their complexity, the extent of their theoretical base and in the evidence of their reliability and validity for their intended uses. In this article, the authors describe important principles for the assessment of grief, and present a rating instrument for use in comparing potential measures for this assessment. Nine of the most widely cited measures are reviewed using this process. Their variations along critical dimensions of assessment quality are clearly demonstrated. The general status of available measures, and recommendations for using this rating process in specific clinical settings are discussed.

Hospice care in Japan.

Hospice care was introduced in Japan in the 1970s. There are currently an estimated 21 programs, which are primarily hospital-based. This paper provides an overview of the history, current state, and future trends of hospice care in Japan. Four programs are described, including staffing information, length of stay, and prognoses of patients. Hospice care in Japan is compared to hospice care in the United States and major differences are described. Lastly, the concept of “truth telling” is explored within the context of the Japanese culture. The discussion is based on a review of the literature and a mailed survey completed by 16 Japanese hospice programs during July 1992. The paper is in four sections: • An overview of Japan. • The history, current state, and future trends of hospice care in Japan. • The major differences between hospice care in Japan and the United States. • An exploration of “truth telling” within the context of the Japanese culture.

A conceptual framework for caring for families of hospice patients.

Hospice caregivers are usually family-focused in their practice with individual clients. Less often is the entire family as a unit considered the client. The authors present a conceptual framework for working with hospice families as clients. Their perspective incorporates concepts of the family as a system, the family life cycle, and the components of professional practice. Clinical examples illustrate the application of the framework in practice.

Hospice research: The importance of program participation

Hospice research is needed in order to understand the complex phenomena of holistic carefor terminally ill persons and their families. Hospice program participation is key to future hospice research efforts. The purpose of this article is to encourage hospice programs to participate in hospice research. The discussion includes why research is done, who undertakes a research project, the role of institutional review boards in assuring rights of human subjects and potential strategies for recruitment of research subjects. The authors use their experiences with conducting hospice research to illustrate potential recruitment strategies.

Building Social Capital: Leading and Leveraging Constituencies Outside the College

Building social capital for a college and discipline requires actively engaging in the work of the university and creating partnerships with stakeholders outside the university, who share common areas of interest. As a public university dean for the past 5 years, I have found this work demands a considerable investment of time, energy, and stamina to maintain the vision of ultimate success. This article discusses three lessons I have learned in this journey as a new dean: serving as dean involves more than your college; a dean must actively engage in the work of the university as a whole and advocate for other colleges within the university; and a dean must take time to engage stakeholders outside the university.

Support utilized by caregivers of terminally ill family members. Clinical implications for hospice team members.

Providing care for the terminally ill and their familieshasbecomeaconcernfor agrowingnumber of healthcare professionals. Terminal illness afflicts not only the patient but also his or her family membersand friends.Thereality of terminalillnessis thata family memberor friend frequentlymust take on the role of acaregiver.This role requiresagreat dealof psychologicalandphysicalstaminaas the terminal illness progressesandeventually leadsto the deathof asignificantperson.Oncethe terminally ill person has died the caregivers face yet another stressfultime, the reintegrationof their liveswithout the deceasedperson. As healthcareprofessionals, weneedto askwhatis helpful to thecaregiver.In otherwords,whatservesto maintainthephysicalandpsychologicalhealthof the caregiverduringthe daysbeforeandafterthedeathof aterminallyill person.Theconceptof socialsupport is onepotentialavenuefor healthcareprofessionalsto explorein this regard. Hamburgetal’ acknowledgethe mediatingeffects of socialsupportonpromotinghealthandresponding to illness.The authorsgo on to suggestthat coping maybe affectedby the availability of support,help, and guidance.The benefitsof social supporthave beendiscussedin termsof abufferingeffect.The influenceof social supporton stresshasbeenviewed with referenceto overall health by a numberof writers.2-7However, the overall effectsof socialsupporton stress,andhealthingeneral,remainapointof controversyin the literature.8 Socialsupportmayprovideapotentialavenuefor helpto the caregiversbeforeandafter the deathof a terminallyill person.Adults experiencingtheterminal illnessanddeathof asignificantpersonarefacedwith a stressful life event which requiresvarious coping skills. In order to copewith theillness or deathof an influential person,the survivormay look to the environmentfor assistanceor to themselvesor both.The theoreticalgroundworkfor the presentinvestigation was laid by LazarusandFolkman.9Their definition of stressemphasizes therelationshipbetweentheperson and the environment.Whenthe relationshipis cognitively appraisedby the personas taxing or exceedinghis or her resources,thenhe or shewill experiencepsychologicalstress.Accordingly, the person’ssenseof well-beingwill beendangered. Basedon the significanceattributedto the person-environment transaction,9it was consideredessentialthat both areasbe reviewed with referenceto the available resources, or sourcesof support. Kalish andKnudtso&°presentoneway of operationalizing the resourcesof the environmentand the person.Theyproposeamodel of attachmentwhich operationalizes ourcesof attachmento includepeople; groups; ideas,beliefs,or values;thingsor places; and self. In order for attachmentto occur, selfproducedfeedbackis necessary.An individual initiatesanactionwhich leadsto asensory,affective,or cognitivestimulus from the attachmentobject.This stimulusleavesthe initiator with a senseof mastery, power,or controlwith self, environmentor others. Reviewingtheliteraturefor aconceptualdefinition of social support leads to one consistent finding: Socialsupportis typically generatedthroughinterpersonalrelationships.Pilisuk7 providesan overviewof the purposeof socialsupportas relationshipsamong people that provide material help, emotional assurance, and the sensethatthepersonis acontinuing object of concernon the part of other people. Lindsey et al’1 view the supportiverelationshipas reciprocal in nature and providing mutual need satisfaction.Sometimesan individual may be the JaneMarieKfrschling, RN, DNS, is AssistantPro-. fessorof Family Nursing, Oregon Health Sciences UniversitySchoolofNursing, Portland, Oregon.

Interprofessional Collaborative Practice

AS PERIANESTHESIANURSES, the care you individually provide to patients and families who are faced with an invasive procedure is critical to the healing process. Equally important is how you engage with other health care providers in optimizing patient-centered care that is safe, high quality, and cost effective. Interprofessional collaborative practice is increasingly a global issue and one that is receiving increased attention in the United States.