Linda L. Eddy

Informal Caregiving to Aging Family Members: A Critical Review

Since the early 1980s, there has been an explosion of literature on caregiving to aging family members. This work appears in a variety of outlets, but mostly in gerontological journals, and somewhat peripherally in journals specifically focused on families. Within the family caregiving literature, there is great ambiguity around three significant questions: (a) What is caregiving? (b) What are the negative and positive outcomes of caregiving for caregivers? and (c) What is the relation between family or informal caregiving and paid or formal caregiving? Confusion in these three areas makes it difficult to compare findings across studies and to draw reliable implications for practice. Thus, we examine the literature on caregiving to aging family members with particular attention to the family aspect of caregiving, addressing these three central questions. Throughout this review, we note assumptions and empirical gaps in the literature, as well as the implications of this literature for researchers and for practitioners who work with family members, particularly the caregivers. WHAT IS CAREGIVING? Most commonly, family caregiving has been conceptualized as occurring when one or more family members give aid or assistance to other family members beyond that required as part of normal everyday life. Generally, family caregiving begins when aging family members require assistance due to debilitating chronic conditions or diseases, such as severe arthritis, significant sensory loss, Parkinsons Disease, Alzheimers Disease, or when they are otherwise frail. A review of the family caregiving literature, however, reveals that a clear and precise definition, which is essential for researchers and for professionals who work with family caregivers, is 1 missing (Barer & Johnson, 1990; Cantor, 1991; MaloneBeach & Zarit, 1991). Caregiving Versus Aid Caregiving is not always easily distinguished from aid given as a part of the normal exchange in family relationships. Some of the difficulty in defining family caregiving rests in the history and nature of the connection between the caregiver and the care receiver. Even when care receivers have similar levels of dependence, the help provided by family caregivers differs by gender and by generation (Dwyer & Seccombe, 1991). For example, using data from the 1982 National Long-Term Care Survey and the associated National Survey of Informal Caregivers, Dwyer and Seccombe (1991) found that caregiving husbands reported giving more care than wives. The authors suggested that caregivers report activities that are not ordinary for them or that are not part of their normal responsibilities. As wives and/or mothers, women perform many tasks, such as laundry, meal preparation, house cleaning, and so on, that are included in measures of instrumental activities of daily living (IADLs; e.g., laundry, meal preparation). Because IADLs are consistent with everyday household work (Sankar, 1993), wives may not consider such tasks to be caregiving activities, but husbands, who are less often involved in household work, and who take on these tasks primarily because their wives are unable to do them, see dusting and vacuuming as caregiving. In the same way, daughters may distinguish the tasks they do in their own households from those they do in the homes of their mothers and fathers. Cleaning house is typically a responsibility of wives in their own homes, but having to do so in another house is caregiving. Similarly, in the National Health Interview Survey, men aged 75 and above were less likely than women to report needing assistance with IADLs, but equally likely to report needing assistance with activities of daily living (ADLs), such as bathing and walking (Pratt, Sasser-Coen, & Acock, 1993). Perhaps older men did not see in themselves a need for IADL assistance because someone had always done these tasks for them, but help with grooming, bathing, and dressing was recognized as aid. …

A Survey of Physical Examination Skills Taught in Undergraduate Nursing Programs: Are We Teaching Too Much?

Because content saturation is a growing concern, as reflected in the nursing literature, the content taught in undergraduate nursing curricula should be critically examined. The purpose of this descriptive cross-sectional research was to determine and analyze the physical assessment content currently taught in undergraduate nursing programs. A total of 198 individuals teaching in undergraduate nursing programs completed a Web-based survey. Of the 122 skills included on the survey, 81% were reportedly being taught in most of the nursing programs. Total scores for 18 systems-based assessment categories were significantly different among associate and baccalaureate nursing programs in all but three categories: assessment of integument, breast, and female genitals. Previous research has shown that nurses use less than 25% of these same skills regularly in clinical practice, regardless of their educational preparation. Findings from this research raise questions about the breadth to which physical examination content should be taught in undergraduate nursing education.

The Impact of Child Disability Type on the Family

&NA; The purpose of this study is to better understand the differential impact of specific diagnoses on outcomes in families with children who have physical disabilities and to suggest ways in which clinicians across disciplines can use that knowledge to develop and implement more individualized, evidence‐based programs. Descriptive statistics, correlation, and a univariate analysis of variance (ANOVA) were used to analyze data gathered from a sample of 205 parents or guardians of children with physical disabilities. Findings revealed a modest effect of diagnosis type on five family outcomes. These outcomes included: (1) how parents or guardians rated their childs current health compared to 1 year before the study, (2) the degree to which the childs physical health caused worry, (3) the degree to which the childs emotional well‐being or behavior caused worry, (4) the degree to which the childs health or behavior limited types of family activities, and (5) the degree to which the childs health or behavior interrupted family activities. This article presents an interprofessional model of response.

The impact of children with chronic health problems on marriage

The authors examined the impact of having a child with a chronic illness or handicapping condition on marital quality and on perceived marital stability. Using data from the National Study of Families and Households (NSFH), married parents caring for a child with a chronic illness or disability (n = 94) were contrasted with married parents of well children (n = 3,693). Data were analyzed using ordinary least squares regression. Neither marital quality nor perceived marital stability differed between the two groups. These results call into question assumptions that children with special needs irreparably harm marriages.

Relevant nursing leadership: an evidence-based programmatic response.

Community and student demand for relevant nursing leadership graduate programs provided the impetus for this study. The aims were to identify components of highly competent nursing leadership, and strategies to integrate those components into education and practice.Nursing leaders gathered in five focus groups. A semi-structured interview guide was used to elicit narratives about nursing leadership. Interpretive analysis proceeded from identification of themes to uncovering of paradigm cases. Essential nursing leadership competencies comprised communication skills such as listening, conflict resolution, the ability to communicate a vision, motivate, and inspire. Additionally, leaders needed technological adroitness, fiscal dexterity, and the courage to be proactive during rapid change. Implications included a revision in the leadership focus of the nursing masters program, and the necessity that nurse retention should be enhanced by better educated nurse leaders who are grounded in practice and ready to provide a vision for the future.

Characteristics of patients who return to the emergency department within 72 hours in one community hospital.

This study identifies characteristics of patients who return to the emergency department (ED) within 72 hr after an initial visit. An exploratory quantitative descriptive study was conducted to identify characteristics of patients with unscheduled 72 hr ED returns. The sample consisted of all patients with 72 hr ED return visits for the month of January 2009 at the study facility. Data were collected from electronic patient records utilizing the National Hospital Ambulatory Medical Care Survey instrument modified to eliminate patient identifiers. There were 169 individuals who had at least one 72 hr return visit to the ED for a total of 393 initial and return ED visits. The most common diagnoses were for gastrointestinal complaints. Over a third of the patients who returned had chronic health conditions. There were more emergency department return visits in individuals who lacked access to primary care.

Evaluation Research as Academic Scholarship

In nursing, the ability of educators to progress successfully toward promotion and tenure may be hampered by heavy teaching or practice workloads and an inability to complete the research mission of the institution. In a 1990 report, Boyer noted that the scholarship of teaching, integration, and application can be embraced in the same manner as the scholarship of discovery and research. One source of data that is often neglected as integral to scholarship is evaluation data that results from teaching, service, and practice. Such data can be reframed and thought of as a compelling avenue for scholarly activity. This article connects the evaluation process with the four types of scholarship outlined in the Boyer model and illustrates how the formal evaluation of a nursing curriculum can be linked to a rigorous scholarship assessment framework.

Experiences of RNs Who Voluntarily Withdraw From Their RN-to-BSN Program

BACKGROUND The number of RN-to-baccalaureate nursing (BSN) programs is increasing; however, nurses continue to voluntarily withdraw at higher rates than expected. METHOD A Heideggerian hermeneutic approach was used to interpret the meaning of the experience of RNs, who voluntarily withdraw from their baccalaureate nursing programs. The research aims were to generate a comprehensive understanding of (a) the experiences of RN-to-BSN noncompleters, (b) the meaning noncompleters ascribe to the experience of dropping out, and (c) the interplay between factors that influence dropout decisions. RESULTS Two overarching patterns of understanding emerged: Withdrawing as Revisiting Failure, and Withdrawing as Impasse: On One Side of the Divide. The factors that influence whether an RN finishes a baccalaureate nursing program are many, but the effect on dignity and well-being are immeasurable. CONCLUSION Voluntary withdrawal from an RN-to-BSN program leaves nurses professionally place-bound, affecting not only the individual nurse but also the profession. [J Nurs Educ. 2017;56(5):260-265.].

Cognitive interviews in patient-reported outcome measures of function for young people with neurodisabilities

The purpose of the paper by Kramer and Schwartz was to examine item interpretability of the Pedatric Evaluation of Disability Inventory–Patient-Reported Outcome (PEDIPRO), which assesses the performance of functional tasks in everyday life. More specifically, it sought to examine the efficacy of an adapted cognitive interview methodology for refining PEDI-PRO items for use by young people with neurodevelopmental disabilities. PROs rely on communication of lived experiences related to specific health conditions by a variety of mechanisms, including cognitive interviews. Although the literature on cognitive interviews with children and adolescents is sparse, their use is important in developing child self-report instruments because of differences in understanding and interpretation of language between adults and children. Irwin et al. used cognitive interviews successfully with typically developing children and adolescents to get feedback on items from patientreported outcomes. Additionally, Eddy et al. used cognitive interviews with children and adolescents with physical disabilities in selecting items for self-report measures. These young people, who had no cognitive issues, had difficulty with evaluative words such as ‘intense’ and ‘severe’. They also had more difficulty with abstract ideas than with more concrete ones. Because poor outcome measures hinder assessment and management of children and adolescents, there is a need to emphasize the child perspective when developing self-report measures. The article by Kramer and Schwartz adds to our current understanding of the efficacy of cognitive interviews in development of PROs for young people by including children and adolescents with neurodevelopmental disabilities. Since most PROs do not include this population in their development, they are inappropriate for their use. This omission is problematic. In a systematic review of the psychometric properties of qualify of life measures for individuals with intellectual disability, Li et al. were unable to find measures that were validated for use with children or adolescents. Although Morris et al. included three young people with neurodisabilities in a study of appropriateness of PROs for young people with neurodisabilities, none of the participants had intellectual disability. Kramer and Schwartz were creative and developmentally sensitive in their approach to including young people with neurodevelopmental disabilities in Pedi-PRO item refinement. For example, they modified the usual cognitive interview procedures by using smaller item sets and asking young people to articulate their thoughts while answering each question. The authors also used an explicit coding scheme for cognitive interview analysis rather than the more typical inductive analysis. Study findings showed that young people with neurodevelopmental disabilities could successfully participate in modified cognitive interviews and that, for the most part, items in the Pedi-PRO were interpreted as intended by this population. The literal interpretation of item candidates is expectable and consistent with the developmental stage of many participants. Similarly, study attrition rate, which was very low, was generally related to expectable communication issues. One interesting finding from this study was that young people had more positive attributions toward the use of internally developed supports to complete tasks than externally developed supports. This is an important area for further exploration as we seek to create effective interventions, including types of supports. Another area that merits deeper exploration is the dilemma about the relative strengths versus challenges of using less difficult items for this population. On one hand, a higher percentage of responses might be captured, but the likelihood of a ceiling effect might occur since most items were interpreted as intended by young people with developmental disabilities. In summary, this article sheds light on the importance and efficacy of including young people with neurodevelopmental disabilities in development of instruments to measure aspects of their health and well-being.