Margaret Sebern

Contributions of Supportive Relationships to Heart Failure Self-Care

Supportive relationships are known to improve outcomes for persons with heart failure (HF). Supporters may do so by improving self-care, but little is known about the influence of supportive relationships on HF self-care. The purpose of this study was to explore background characteristics associated with supportive relationships, and the contribution of supportive relationships to HF self-care. The construct of shared care was used to operationalize supportive relationships. Shared care refers to a system of interpersonal processes (communication, decision making, and reciprocity) used in close relationships to exchange support. A cross sectional design was employed recruiting 75 HF dyads. Older patients who perceived their health as better reported better shared care communication. Spouse dyads perceived more reciprocity in their relationship than non-spouse dyads. The process of patient shared care decision making was related to HF self-care maintenance (r = 0.65) and self-care confidence (r = 0.52). Patient communication (r = 0.24) and reciprocity (r = 0.41) were related to self-care confidence. Caregiver decision making (r = 0.29) contributed to self-care maintenance; and caregiver decision making (r = 0.37) and reciprocity (r = 0.35) contributed to self-care confidence. These findings suggest that augmenting the processes of shared care may be a valuable focus for future intervention research.

Pressure ulcer management in home health care: efficacy and cost effectiveness of moisture vapor permeable dressing

This prospective randomized study was conducted in the home care setting to compare healing rates and costs of two different dressings for pressure ulcers: the gauze and tape dressing and the transparent moisture vapor permeable dressing (MVP). Demographic variables, healing rates, and cost of treatment were statistically analyzed for 77 pressure ulcers (48 patients). Each wound was randomly assigned to either a gauze dressing or a MVP dressing. Initial ulcer grade (Shea criteria) and measurements were determined at the start of treatment and weekly for an eight-week period. Photographs of the wound were taken at the beginning and end of treatment. The same protocol for irrigating the wound and relieving pressure was followed for both dressing groups. The median improvement for the grade II group was 100% for the MVP (n = 22) and 52% for gauze (n = 12), p less than 0.05 (Wilcoxon rank sum test). The healing rates for grade III ulcers were not significantly different in the two dressing groups. The mean (eight-week) labor and supply cost per ulcer using the MVP was

Shared Care Dyadic Intervention Outcome Patterns for Heart Failure Care Partners

845, while that for gauze treatments was

Refinement of the Shared Care Instrument-Revised: A Measure of a Family Care Interaction

1359, p less than 0.05 (Wilcoxon rank sum test). The cost difference for grade III ulcers was not significant in the two dressing groups. The MVP improved the healing rate and was more cost effective for grade II ulcers. Both gauze and MVP dressings proved effective for the treatment of grade III ulcers.

Psychometric evaluation of the Shared Care Instrument in a sample of home health care family dyads.

Up to half of heart failure (HF) patients are readmitted to hospitals within 6 months of discharge. Many readmissions are linked to inadequate self-care or family support. To improve care, practitioners may need to intervene with both the HF patient and family caregiver. Despite the recognition that family interventions improve patient outcomes, there is a lack of evidence to support dyadic interventions in HF. Thus, the purpose of this study was to test the Shared Care Dyadic Intervention (SCDI) designed to improve self-care in HF. The theoretical base of the SCDI was a construct called Shared Care. Shared Care represents a system of processes used in family care to exchange support. Key findings were as follows: the SCDI was acceptable to both care partners and the data supported improved shared care for both. For the patient, there were improvements in self-care. For the caregivers, there were improvements in relationship quality and health.

Shared Care Contributions to Self-Care and Quality of Life in Chronic Cardiac Patients

This study’s purpose was to evaluate the psychometric properties of the Shared Care Instrument-Revised (SCI-R) in a sample of family care dyads. The SCI-R was developed to measure the construct of shared care, which is a system of three constructs (communication, decision making, reciprocity) used in family care to exchange support. An important aspect of evaluating the SCI-R was to create a measure that is statistically sound and meaningful for patient and caregivers. Surveys were mailed to randomly selected home health dyads, which included 223 patients and 220 caregivers. Reliability and confirmatory factor analysis, and concurrent validity were examined. Internal consistency reliability of the patient subscales ranged from 0.74 to 0.76, and from 0.72 to 0.78 for caregiver subscales. Factor analysis supported the underlying theoretical basis of the SCI-R. Construct validity also was supported using the hypothesis-testing approach. One major challenge in family care research is to develop methods and tools to study the dynamic characteristics of close relationships. The findings from this study support further use of SCI-R to study how shared care facilitates the exchange of support and the influence shared care has on outcomes for both patients and caregivers.

Work System Analysis of Home Nursing Care and Implications for Medication Errors

Researchers have studied negative effects of caregiving on a family caregiver; however, less is known about positive aspects of exchanging assistance for both members of a family caregiving dyad. In a previous naturalistic inquiry the author indentified a basis for studying caregiving interactions was a construct called shared care. The three components of shared care identified in the naturalistic inquiry were communication, decision making, and reciprocity. The Shared Care Instrument (SCI) was developed to measure the construct. The purpose of this study was to assess the psychometric properties of the SCI, and to assess its construct and criterion-related validity, A sample of home care family dyads (110 patients and 109 family members) returned usable survey questionnaires. Results indicated the Cronbachs alphas for the patient group for the SCI subscales ranged from .78 to .84, and .77 to .79 for family members. Factor analysis supported the underlying theoretical basis and factor structure of the SCI. Criterion-related validity was also supported. Therefore, the results of this study provide initial evidence for the reliability and validity of the SCI for use with family caregiving dyads. The findings support the need for additional testing of the SCI.

Self-Care Behaviors of African Americans Living with Heart Failure

Shared care is an interpersonal interaction system composed of communication, decision making, and reciprocity; it is used by patients and family caregivers (care dyads) to exchange social support. This study’s purpose was to describe the contributions of shared care to outcomes for individuals with cardiac disease. A secondary data analysis was used to answer the following questions. What is the association between elements of shared care and patient outcomes? Do dyad perceptions of shared care differentially contribute to patient outcomes? Participants in this study were 93 individuals with a cardiac disease and 93 family caregivers. Composite index structured equation modeling was the analytic tool. Caregiver communication and reciprocity were related to patient mental quality of life. Patient communication and reciprocity were related to their own mental and physical quality of life and self-care confidence. Findings from this study contribute a better understanding of how care dyads are integral to patient outcomes.

Psychometric Testing of the Self-Care of Heart Failure Index

The purpose of this study was to examine the context of the provision of home nursing care for patients with congestive heart failure. A modified macroergonomic analysis and design work system analysis was undertaken in two phases with fourteen nurse participants: I) field observations of eight nurses for the collection of data on work elements and II) follow-up telephone interviews with six home care nurses. Open-ended questions were asked after the observations to identify clinical knowledge, policies, and procedures that influenced care decisions and practices. The telephone interviews focused on four different aspects of home health care delivery and were conducted using semi-structured questions. Results of the observations were translated into flowcharts and a summary report. The baseline findings described aspects of home medication management and its relevance to safety, quality of care, communication, and self-management.

Dyadic Relationship Scale: A Measure of the Impact of the Provision and Receipt of Family Care

African Americans have a higher risk of developing heart failure (HF) than persons from other ethnic groups. Once diagnosed, they have lower rates of HF self-care and poorer health outcomes. Promoting engagement in HF self-care is amenable to change and represents an important way to improve the health of African Americans with HF. This study used a community-based participatory action research methodology called photovoice to explore the practice of HF self-care among low-income, urban, community dwelling African Americans. Using the photovoice methodology, themes emerged regarding self-care management and self-care maintenance.