Marsha L. Lewis

Internet-Based Program for Dementia Caregivers:

The overall goal of the Internet-Based Savvy Caregiver (IBSC) program was to develop and bring to market an Internet-based psycho-educational program designed to provide dementia caregivers the knowledge, skills, and outlook they need to undertake and succeed in the caregiving role they have assumed. The IBSC program’s concept is based on a face-to-face caregiver-training program and curriculum, the previously validated Savvy Caregiver Program (SCP). The project used an iterative design with expert and consumer input to develop the initial prototype. Forty-seven participants completed the IBSC program and follow-up questionnaire. Results of the formative evaluation showed that participants found the program educational, convenient, useful, and interesting. Participants endorsed feeling more confident in caregiving skills and communication with their family members. The evidence points to the feasibility of an Internet-based program to strengthen family caregivers’ confidence in caring for persons with dementia.

Decision-making task complexity: model development and initial testing.

Preparing skilled decision-makers requires an understanding of the decision-making tasks nurses face. This article presents the development and initial testing of a model of decision-making task complexity in nursing. The Decision-Making Task Complexity Model has its roots in Newell and Simons (1972) Information Processing Theory. The Model includes two components, content and context, along with five characteristics in each component. The content component of the model was initially tested using a single sample repeated measures design. Case study examples of a weaning task in critical care were developed to include all combinations of the four independent variables: irrelevance, ambiguity, conflict, and change. Forty-one registered critical care nurses rated each case study example on a scale from 1 (least complex) to 7 (most complex). Results indicated that when conflict was manipulated the ratings were consistently higher. Implications for nursing education and the development of decision-making skills are described.

Relationship matters in demantia caregiving

This study examined the relationship between four framing categories of caregiving (Relational, Instrumental, Reactive, Role Acquiring), derived from interviews with spouse caregivers, and scores on standardized measures of responses to and outcomes of caregiving. Participants were 132 spouses recruited into a larger intervention study of family caregivers of communitydwelling persons with dementia. Qualitative data were analyzed using constant comparative method; quantitative data were analyzed using one-way analysis of variance (ANOVA). Findings demonstrated that relational spouses scored better than spouses in the other three categories, indicating greater positive well-being. Relational spouses also scored significantly lower than instrumental and reactive spouses on a composite caregiver distress measure (p = 0.003). These results suggest that interventions may need to be tailored to spouses with different caregiving perspectives.

Discourse-derived Perspectives: Differentiating Among Spouses' Experiences of Caregiving

A method of constant comparative analysis was used to code open-ended interviews with 132 spouse caregivers regarding their experiences in caregiving. Results of this analysis yielded 69 qualitative code categories. We used these categories to compare the caregivers on several groupings that the literature has identified as providing meaningful ways to differentiate among caregivers. We used the qualitative responses to compare the caregivers by caregiver gender, care-recipient dementia severity, and duration of caregiving. Results partly confirmed previous findings that wife caregivers are more distressed than husbands, but the results also indicated these caregivers were more similar than dissimilar. The other analyses likewise indicated greater similarities than dissimilarities in the caregiving experience. We next continued the analysis and, using the coding categories as a springboard, identified four distinct patterns for construction of the meaning of the caregiving experience in the caregivers’ discourse. These discourse-derived framing categories, applicable in about three-quarters of the caregivers, offered other ways to distinguish among caregivers. Further analysis of these robust groupings showed important differences among the groups. These framing categories suggest ways to differentiate among caregivers, based on their perception of their role in the caregiving situation, ways that might point the way to intervention strategies for each of the groupings.

Challenges of teaching graduate psychiatric-mental health nursing with distance education technologies

As student demographics change and distance educational technology continues to evolve, faculty teaching advanced psychiatric-mental health nursing are attempting to meet the needs of students at distant sites through telecommunications. Graduate education in psychiatric-mental health nursing at the University of Minnesota School of Nursing has used distance education technology since 1994. The use of technology, such as interactive television, audio and audio/video telephone conferencing, facsimile, and electronic mail to teach has been exciting and challenging. This article discusses challenges related to connectedness, confidentiality, and communication; describes approaches to address these challenges; and identifies student, faculty, and environmental attributes that help make teaching with this technology successful.

Decision-making by family caregivers of elders experiencing dementia

Families provide the majority of care for persons with Alzheimers disease. Multiple aspects of caregiving, including decision-making, lead to caregiver burden and stress. The purpose of this pilot study was to describe the decision situations faced by caregivers. Nine female spouse caregivers participated in focus groups to solicit the decision situations they faced while caring for their husbands. Some 183 decision situations were grouped into 14 decision-making topics and five other topical categories: physical safety and wellness; cognitive and emotional; relationships; caregiver well-being; and legal. Categories were organized under two themes: decision situations related to self-care and decision situations related to spouse care. The majority of decision situations relate to maintaining the caregivers well-being. Implications for nursing and further study are discussed.

Women's approaches to decision making about mammography

Health professionals have an obligation to understand womens decision making about mammography and to advocate for their active participation in health care decision making. Although mammography is a major screening measure for the second largest cancer killer of women, only approximately half of women older than age 50 years, and fewer older than age 70 years, undergo mammography in accordance with American Cancer Society (ACS) guidelines. Therefore, the purpose of this study was to identify womens overall decision-making approaches when considering mammography. Subjects were a purposive, convenience sample of 50 women in the community who had made a decision about mammography; they included those who chose to have mammograms and those who decided not to have mammograms according to the pre-1997 ACS guidelines. Subjects participated in audiotaped interviews. Results indicated that women approached the mammography decision differently, regardless of the decision they made. Three overall decision-making approaches to addressing risk factors, issues about mammography, or other factors before their decision were evident. The approaches were (1) thoughtful consideration; (2) cursory consideration; and (3) little or no consideration. Each approach has implications for nurses who assist women in making decisions about mammography.

Caregiving Experiences of Family Members of Persons With Dementia in South India

This study reports on the first phase of an investigation aimed at adapting The Savvy Caregiver program, a successful family caregiving curriculum developed in the United States, for application in South India. Thirty family members caring for a person with dementia were interviewed regarding their experiences as caregivers (CGs). Qualitative interviews were conducted with the family member at a geriatric clinic, while other diagnostic procedures were being carried out with the person with dementia. Findings from the study revealed that although family members understood the term CG, none could identify a word for CG in his or her language. There was little understanding of dementia as an illness. Family CGs reported feeling distressed, overwhelmed, and frustrated with caregiving. Caregivers were interested in an educational program, but many had unrealistic expectations for what they wanted to learn. The findings provide directions for adapting The Savvy Caregiver curriculum for Indian family CGs.

Cognitive behavioral group therapy for residents in assisted-living facilities

Geriatric depression is a disabling illness that is associated with increased morbidity and mortality and deserves aggressive and early intervention. Cognitive-behavioral group therapy is an effective intervention for the treatment of geriatric depression and can be used with residents in an assisted living facility to manage and prevent depression. Cognitive-behavioral group therapy protocol modifications for residents in assisted-living facilities aids their participation and learning.

Violence against nurses in outpatient mental health settings

Nurses in outpatient mental health settings who have been assaulted may have an increased sense of vulnerability. Assault and verbal threats influence how nurses view client behavior. Mechanisms need to be developed to protect staff in outpatient settings and to support colleagues when assaults or threats occur.