Linda R. Phillips

An Adaptation of Brislin’s Translation Model for Cross-cultural Research

BackgroundThe number of nurse scientists pursuing cross-cultural research using quantitative designs is increasing. Preparation of instruments that are conceptually and functionally appropriate in the language of the participants is a complex process that needs examination. ObjectivesBrislin’s classic model for translation and validation of instruments for cross-cultural research is critiqued. Adaptations and extensions of that model are recommended. MethodsBrislin’s model guided tool preparation in a cross-cultural investigation. The process is described and lessons learned are outlined and discussed. ConclusionsSteps toward a more efficient and valid approach to the preparation of instruments are suggested.

NURSING INTERVENTIONS TO PROMOTE FUNCTIONAL FEEDING

Results of this study suggest that specific nursing protocols can be designed to promote functional feeding for demented elders in nursing homes while enhancing the mealtime environment for both the demented elders and their caregivers. By nurses altering the feeding environment (context) alone, subjects received more food and drink, refused less food and showed more self-feeding. Major findings were that subjects demonstrated increased independence by refusing food more often and initiating self-feeding more frequently.

The Relevance of Familism in Cross-Cultural Studies of Family Caregiving

Although familism has been studied in both Mexican American and Anglo families, there is controversy about whether familism in both groups is the same. Research has shown great within-group variability, and in addition, the kinship structure in the two groups isfundamentally different. This article explores the cross-cultural issues in conceptualizing familism and its relevance to caregiving among Anglo and Mexican American caregivers. Based on data obtained in an ongoing research program, the process of arriving at similarities and differences in the expression of familism is discussed using Berrys criteria for achieving cultural equivalence.

Caring for the frail elderly at home: toward a theoretical explanation of the dynamics of poor quality family caregiving.

Using the grounded theory approach, 39 family caregivers were theoretically sampled using newspaper advertising to explore their perceptions of providing home care for frail elders and to generate a theoretical model that describes the dynamics of good quality and poor quality family caregiving; explains the relationships among certain contextual and perceptual variables and the behaviors exchanged by elders and caregivers; and identifies points where interventions by nurses could be effective. The model consists of five constructs that were identified from the data and were staged within the framework provided by symbolic interactionism and social exchange theory. The five constructs and two related driving forces provide a partial explanation for the quality of family caregiving and a beginning explanation for the phenomenon of elder abuse.

The Mexican American caregiving experience

Although family caregiving among non-Hispanic Whites (NHW) has been studied extensively, relatively little is known about the caregiving experience in Mexican American (MA) families. This article compares 196 MA caregivers to 165 NHW caregivers and describes differences in the caregiving structure and caregiving experience. For caregiving structure, more MA caregivers were adult children even though the elder had a living spouse, MA caregivers provided less help, fewer MAs lived with elders, and MA elders had better functional abilities, in spite of having similar health problems to their NHW counterparts. For caregiving experience, MA caregivers had and used less social support, felt less social restriction and less change in elder-caregiver-family relationships, had poorer health, and evaluated their role performance better than NHW caregivers.

The QUALCARE Scale: developing an instrument to measure quality of home care

In previous research, the theoretical and methodological problems associated with operationalizing elder abuse have been multiple. The QUALCARE Scale was developed in response to the documented problems. The scale is an observational rating scale designed to quantify the quality of family caregiving to home-dwelling elders in six areas: physical, medical management, psychosocial, environmental, human rights and financial. The scale is a 53 item scale in a Likert type format. The QUALCARE Scale is completed by professional nurses after a nursing assessment of the degree to which the caregiver meets the needs of the elder in the six dimensions. The nursing assessment involves both observations and verbal data gathering. In this paper, the development of the scale and the methodological issues associated with scale development are discussed.

Beyond Textual Perfection: Transcribers as Vulnerable Persons

Primarily women, transcribers are essentially invisible persons, paid to serve as nameless, faceless technicians even though they participate in a transformative auditory experience. Transcribers are drawn into the lives of research participants through hearing the details of their everyday lives and extraordinary circumstances. Exploring the work worlds of transcribers, the authors point to the need to consider transcribers as persons. Transcribers may require the protection of ethical and institutional review committees to prevent emotional injury during the course of sensitive research. Protecting transcribers can include ethical review to examine the possibility of transcriber vulnerability and appropriate researcher interventions fully informing transcribers about the nature of the research and the data that will be collected before hiring takes place, establishing regular debriefing sessions, alerting the transcriber in advance of receiving particularly difficult interviews, and preparing transcribers for the termination of a study.

Feeding nursing home residents with Alzheimer's disease

The purpose of this exploratory, descriptive study was to identify and categorize the behaviors of caregivers and residents that elicit, sustain, or extinguish feeding. Although preliminary analysis yielded initial categories, mutually exclusive categories were difficult to distinguish. Relationships among identified cues and specific feeding behaviors are being examined in further analysis. The relationship between specific feeding behaviors and the environmental context of feeding is also being examined. The goals of studying feeding behaviors in nursing home residents with Alzheimers disease are to enhance mealtime for both residents and caregivers and to encourage functional feeding behavior as much as possible. Identification of behaviors that elicit, sustain, and extinguish functional feeding can facilitate development of behavioral and environmental nursing interventions to promote functional feeding.

Challenges in Language, Culture, and Modality: Translating English Measures Into American Sign Language

Background: Few health-related questionnaires have been translated into American Sign Language (ASL), precluding Deaf adults from full participation in health-related research. Objectives: To translate self-report measures (written English) into sign language and to evaluate the equivalence of the ASL versions to the original English versions of the measures. Methods: A descriptive-comparative design with a derived etic (outsider) perspective was used to evaluate equivalency between the English version of the Self-Rated Abilities for Health Practices (SRAHP) and an ASL version. Both versions were administered to 24 bilingual (English and ASL) adults. Analysis included correlation between total scores and comparison of internal consistency of both versions; psychometric properties of the signed SRAHP were computed for 105 Deaf adults who participated in a study of the Deaf Heart Health Intervention (DHHI). Results: The correlation between total scores on ASL and English versions was .92, item-to-total correlations ranged from .08 to .80 on the English version and from .33 to .80 on the ASL version. Cronbachs alpha was .91 for the English version and .90 for the ASL version. Mean scores on the ASL version were significantly lower for the all-Deaf DHHI sample (n = 105) than for the bilingual subjects (n = 24) although internal consistency remained high (Cronbachs alpha of .93 and item-to-total correlation of .38-.74) for the new ASL version. Discussion: The use of an adapted translation model resulted in a sound ASL version of a health-related measure. Results support use of the derived etic strategy for translating measures from their original language into new languages. The approach is also appropriate for changing modalities from written form to other modalities, such as the visual-manual modality of ASL.

Ethical reasoning associated with the feeding of terminally ill elderly cancer patients. An international perspective.

An international nursing research study examined the ethical decision-making of “good and experienced” registered nurses in eight countries. The subjects were asked about their decision to feed or not to feed a hypothetical terminally ill, mentally alert, elderly cancer patient who refuses to eat. Cultural variations were demonstrated in the decisions as well as differences in ethical justification. The majority of nurses who would not feed appeared to use the principle of autonomy, whereas nurses who would feed the patient used beneficence as justification. Conditions under which nurses would change their decision to either feed or not feed the patient against her will included doctors orders and lack of peer support for the decision. The majority of nurses clearly experienced a dilemma.