Jason W. Beckstead

Confirmatory factor analysis of the Maslach Burnout Inventory among Florida nurses

Burnout among human service professionals, such as nurses, has been studied in various countries for years using the Maslach Burnout Inventory (MBI). This paper reports on confirmatory factor analyses using LISREL that examined the factorial validity of the MBI. The sample consisted of 151 registered nurses from west-central Florida. Modifications of the initial hypothesized three-factor structure were necessary to adequately fit the data. Findings are compared to the published normative values for the MBI and to similar studies of European nurses. Recommendations for measurement models of the MBI in future studies that use structural equation modeling techniques are offered.

The effects of a tailored cardiac rehabilitation program on depressive symptoms in women: A randomized clinical trial

BACKGROUND Depression is known to co-occur with coronary heart disease (CHD). Depression may also inhibit the effectiveness of cardiac rehabilitation (CR) programs by decreasing adherence. Higher prevalence of depression in women may place them at increased risk for non-adherence. OBJECTIVE To assess the impact of a modified, stage-of-change-matched, gender-tailored CR program for reducing depressive symptoms among women with CHD. METHODS A two-group randomized clinical trial compared depressive symptoms of women in a traditional 12-week CR program to those completing a tailored program that included motivational interviewing guided by the Transtheoretical Model of behavior change. Women in the experimental group also participated in a gender-tailored exercise protocol that excluded men. The Center for Epidemiological Studies Depression (CES-D) Scale was administered to 225 women at baseline, post-intervention, and at 6-month follow-up. Analysis of Variance was used to compare changes in depression scores over time. RESULTS Baseline CES-D scores were 17.3 and 16.5 for the tailored and traditional groups, respectively. Post-intervention mean scores were 11.0 and 14.3; 6-month follow-up scores were 13.0 and 15.2, respectively. A significant group by time interaction was found for CES-D scores (F(2, 446)=4.42, p=.013). Follow-up tests revealed that the CES-D scores for the traditional group did not differ over time (F(2, 446)=2.00, p=.137). By contrast, the tailored group showed significantly decreased CES-D scores from baseline to post-test (F(1, 223)=50.34, p<.001); despite the slight rise from post-test to 6-month follow-up, CES-D scores remained lower than baseline (F(1, 223)=19.25, p<.001). CONCLUSION This study demonstrated that a modified, gender-tailored CR program reduced depressive symptoms in women when compared to a traditional program. To the extent that depression hinders CR adherence, such tailored programs have potential to improve outcomes for women by maximizing adherence. Future studies should explore the mechanism by which such programs produce benefits.

Content validity is naught

Content validation theory and practice have received considerable attention in the nursing research literature. This paper positions the discourse within the broader scientific literature on validity of measurement. The content validity index has been recommended as a means to quantify content validity; this paper critically examines its origins, theoretical interpretations, and statistical properties. In addition, the author sets out to understand why many nurse researchers are occupied with content validity and its estimation. This investigation may be of interest to the scholar who desires to deeply understand the issues surrounding validity of measurement.

Dual processing model of medical decision-making.

BackgroundDual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease.MethodsWe developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice.ResultsWe show that physician’s beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker’s threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice.ConclusionsWe have developed the first dual processing model of medical decision-making that has potential to enrich the current medical decision-making field, which is still to the large extent dominated by expected utility theory. The model also provides a platform for reconciling two groups of competing dual processing theories (parallel competitive with default-interventionalist theories).

Predicting cardiac rehabilitation attendance in a gender-tailored randomized clinical trial.

PURPOSE This study compared attendance of women participating in a motivationally enhanced, gender-tailored cardiac rehabilitation (CR) program with that of women attending a traditional outpatient CR program. We also sought to determine the significant baseline predictors of attendance of the exercise and education components of the interventions. METHODS Data from 252 women with CHD in the randomized clinical trial, the Womens-Only Cardiac Rehabilitation Program, were used in this study. The experimental design used 2 treatment groups: both receiving a comprehensive, 12-week, CR program, with 1 group receiving a gender-tailored, stage-of-change matched, behavioral enhancement using individualized motivational interviewing. RESULTS Compared with women in the traditional CR program, women in the gender-tailored program attended significantly more of the prescribed exercise (90% vs 77%) and education sessions (87% vs 56%). Group assignment accounted for about 5% of the variance in exercise attendance (F1,250 = 12.755, P < .001) and about 24% of the variance in education attendance (F1,250 = 77.942, P < .001). After controlling for group assignment, the baseline characteristics of smoking status, marital status, and anxiety accounted for about 17% of the variance in exercise attendance (F5,245 = 10.494, P < .001). Smoking status and marital status were significant baseline predictors of education attendance (F5,245 = 6.115, P < .001) after controlling for group assignment. CONCLUSIONS The long-standing, poor attendance of women in CR continues to be an unresolved international challenge. Gender-tailored, stage-matched, CR programs hold promise for enhancing attendance to prescribed protocols. Additional research examining the efficacy of gender-sensitive, motivationally enhanced CR for women compared with generic CR programs is warranted.

Predicting Falls in Older Patients Using Components of a Comprehensive Geriatric Assessment

This prospective study evaluated components of a comprehensive geriatric assessment (CGA) to identify rates and predictors of falls in older patients. Fall rates and scores on components of the CGA were compared among adults aged 70 or older in three groups: patients with cancer receiving chemotherapy, patients with cancer not receiving chemotherapy, and community-dwelling adults without cancer. Older adults in the chemotherapy group were hypothesized to fall significantly more often than those in the nonchemotherapy group. Among the patients with cancer, scores on the Activities of Daily Living Scale were a significant predictor of falls. The scores were the only domain of the CGA found to be a significant predictor; therefore, more research is needed to better understand fall risk assessment among older patients with cancer. Nurses should conduct fall risk assessments with measures of functional status as included in a CGA.

Using Hierarchical Cluster Analysis in Nursing Research

This article is a pedagogical piece on hierarchical cluster analysis, a method for investigating the structure underlying data. Such methods are useful for finding similar groups of cases in data sets when it is not known a priori how many groups are present. The article is laid out as follows: First, a brief history and overview of the methods is presented; second, an illustrative example with a small hypothetical data set is used to clarify fundamental concepts; third, hierarchical cluster analysis is applied to a data set from the author’s own program of research to illustrate one way in which the methods may be employed in nursing research; fourth, the limitations of the methods are discussed; and finally, a list of suggested readings, at varying levels of detail, are provided for the interested researcher.

The effects of a cardiac rehabilitation program tailored for women on their perceptions of health: a randomized clinical trial.

PURPOSE: The aim of this study was to compare the effects of a cardiac rehabilitation (CR) program tailored for women with a traditional program on perceptions of health among women with coronary heart disease. METHODS: This 2-group randomized clinical trial compared the perceptions of health among 92 women completing a traditional 12-week CR program with those of 133 women completing a tailored program that included motivational interviewing guided by the transtheoretical model of behavior change. Perceptions of health were measured using the SF-36 Health Survey at baseline, postintervention, and at 6-month follow-up. Analysis of variance was used to compare changes in SF-36 Health Survey subscale scores over time. RESULTS: The group-by-time interaction was significant for the general health (F2,446 = 3.80, P = .023), social functioning (F2,446 = 4.85, P = .008), vitality (F2,446 = 5.85, P = .003), and mental health (F2,446 = 3.61, P = .028) subscales, indicating that the pattern of change was different between the 2 groups. Of the 4 subscales on which there were significant group-by-time interactions, the tailored group demonstrated improved scores over time on all 4 subscales, while the traditional group improved on only the emotional role limitations and vitality subscales. CONCLUSIONS: A tailored CR program improved general health perceptions, mental health, vitality, and social functioning in women when compared with traditional CR. To the extent that perceptions of health contribute to healthy behaviors fostered in CR programs, tailoring CR programs to alter perceptions of health may improve adherence.

The Effects of a Cardiac Rehabilitation Program Tailored for Women on Global Quality of Life: A Randomized Clinical Trial

BACKGROUND Women with heart disease have adverse psychosocial profiles and poor attendance in cardiac rehabilitation (CR) programs. Few studies examine CR programs tailored for women for improving their quality of life (QOL). METHODS This randomized clinical trial (RCT) compared QOL among women in a traditional CR program with that of women completing a tailored program that included motivational interviewing guided by the Transtheoretical Model (TTM) of behavior change. Two measures of QOL, the Multiple Discrepancies Theory questionnaire (MDT) and the Self-Anchoring Striving Scale (SASS), were administered to 225 women at baseline, postintervention, and 6-month follow-up. Analysis of Variance (ANOVA) was used to compare changes in QOL scores over time. RESULTS Baseline MDT and SASS scores were 35.1 and 35.5 and 7.1 and 7.0 for the tailored and traditional CR groups, respectively. Postintervention, MDT and SASS scores increased to 37.9 and 7.9, respectively, for the tailored group compared with 35.9 and 7.1 for the traditional group. Follow-up scores were 37.7 and 7.6 for the tailored group and 35.7 and 7.1 for the traditional group. Significant group by time interactions were found. Subsequent tests revealed that MDT and SASS scores for the traditional group did not differ over time. The tailored group showed significantly increased MDT and SASS scores from baseline to posttest, and despite slight attenuation from posttest to 6-month follow-up, MDT and SASS scores remained higher than baseline. CONCLUSIONS The CR program tailored for women significantly improved global QOL compared with traditional CR. Future studies should explore the mechanisms by which such programs affect QOL.

Modeling Women’s Quality of Life after Cardiac Events

Quality of life (QOL) is presented as a global, unidimensional, and subjective assessment of one’s life. This study examined the impact of perceived health status, hope, and optimism on QOL in 93 women after suffering a cardiac event. Construct validity was examined by estimating a model where QOL was measured with four indicators, and perceived health was measured with the SF-36 Health Survey. Hope was measured with the Herth Hope Index and dispositional optimism was measured with the Life Orientation Test. The unidimensionality of QOL and its response to health status, hope, and optimism were tested. Fit indices suggested that the theoretical relations posited were compatible with the data, ([.chi]2 (42) = 44.125, p = .382, RMSEA = .0001, GFI = .942). The model explained 66% of the variance in QOL. Modeling suggested the presence of a complex latent concept composed of hope and optimism that influenced QOL.