Michele C. Clark

Depression in family caregivers of elders: A theoretical model of caregiver burden, sociotropy, and autonomy

To test the diathesis-stress model for family caregivers, two structural equation models were developed to explain depression measured by the Center for Epidemiologic Studies Depression Scale. A cross-sectional convenience sample of 112 caregivers completed questionnaires to measure burden, personality traits, dysfunctional attitudes, and depression. The final model included direct paths from caregiver burden to autonomy and sociotropy, and indirect paths from burden to depression through sociotropy and autonomy. The final model fit adequately (chi(2) [224, N = 112] = 308.60, p < .00; CFI = .951; RMSEA = .058). Levels of burden influenced caregiver depression scores. One pathway to depression was though the personality traits of sociotropy and autonomy; both had a larger influence on depression scores than burden alone.

Mediators of adherence among adults with comorbid diabetes and depression: The role of self-efficacy and social support

Depression and diabetes have been linked in a variety of ways, and the presence of depression in those with diabetes can negatively affect adherence to care recommendations. A sample of 201 participants with Type 2 Diabetes completed a cross-sectional survey that assessed depressive symptoms, adherence, self-efficacy, social support, and personal characteristics. Multiple regression analysis was used to test whether self-efficacy and social support mediate the relationship between depressive symptoms and adherence. The findings suggest complete mediation via self-efficacy and some types of social support. Intervening to bolster self-efficacy and social support may decrease the negative effect of depression on adherence.

Development and psychometric testing of the Health Beliefs Related to Cardiovascular Disease Scale: preliminary findings

AIM This paper is a report of an evaluation of the psychometric properties of the Health Beliefs Related to Cardiovascular Disease Scale designed to measure beliefs related to cardiovascular disease risk and diet and exercise in adults with diabetes. BACKGROUND Heart attack and stroke are 2-4 times more common among adults with diabetes than those without diabetes. To reduce this risk for patients with diabetes, understanding beliefs about cardiovascular disease risk and risk-reduction strategies is important. METHODS Item development for the 25-item self-report Likert scale was guided by literature review, expert panel review and focus-group feedback. It consists of four subscales, measuring four constructs of the Health Belief Model: perceived susceptibility and severity of cardiovascular disease and benefits and barriers to diet and exercise. A convenience sample of 178 adults with self-reported type 2 diabetes completed the survey between August 2006 and March 2007; 42 participants completed it again 2-3 weeks later to evaluate test-retest reliability. RESULTS The instrument has more than one dimension, with the best fit identified using a two-factor model specifying the Benefits and Susceptibility subscale items, rather than the four-factor solution as predicted. The Susceptibility and Benefits subscales demonstrated stable factor structure and acceptable reliability (α = 0·93 and α = 0·82 respectively). The Barriers and Severity items demonstrated unstable factor structure and poor internal consistency (α = 0·70 and α = 0·61 respectively). CONCLUSION Only the Susceptibility and Benefits subscale items can be used in their current form. The Barriers and Severity items need further refinement including revised wording with clearer focus and evaluation with a larger, more diverse sample.

Preparing Students for Flipped or Team-Based Learning Methods

Purpose – Teaching methods such as Flipped Learning and Team-Based Learning require students to pre-learn course materials before a teaching session, because classroom exercises rely on students using self-gained knowledge. This is the reverse to “traditional” teaching when course materials are presented during a lecture, and students are assessed on that material during another session at a later stage. The purpose of this paper is to describe an introductory class session that prepares and engages students to be successful participants in courses requiring pre-learning. Design/methodology/approach – A sequence of seven learning activities drawn from the education literature was implemented in an introductory undergraduate entrepreneurship class. These activities were evaluated using exploratory qualitative research. Findings – Student evaluations of the learning activities showed that they readily identified important aspects of learning, critical factors related to student success, and the learning pur...

Psychosocial and Biological Indicators of Depression in the Caregiving Population.

Estimates suggest that 25–50% of family caregivers experience depression. Recent research has linked psychological stress and depression symptoms to increased cytokine activity. This study was designed to investigate the predictors of high cytokine levels and their influence with personality factors on depression in a caregiving population. The authors examined the relationship between caregiving burden and depression through the influence of sociotropy, autonomy, and cytokine levels in a sample of 106 caregivers who were actively caring for an elderly dependent in the community. Though the authors did not establish a mediation model, they found that the personality sub-factors of sociotropy, predicted tumor necrosis factor receptor (TNFR1) levels, while burden significantly predicted interleukin-6 and C-reactive protein (CRP) levels. Additionally, burden and TNFR1 levels predicted depression, with greater burden and TNFR1 levels predicting increased depression severity. Study findings point to a need for early interventions for caregivers to prevent increases in stress and cytokine levels and the development of depression.

A Cultural Paradox: Elder Abuse in the Native American Community:

An emerging cultural paradox in the Native American community is the long history of respect for elders and the emergence of elder abuse as a problem. Elders commonly hold a special and respected place in traditional Native American societies due largely to their experience, knowledge, wisdom, and power as dreamers, healers, and teachers. Although violence against other tribal members is considered as unnatural and a threat to internal spiritual harmony, victimization, and abuse of elders and is recognized as a clandestine but increasing problem in the Native American community. This challenges health care providers and tribal members to provide safe and culturally congruent care to the elderly as well as coming to terms with this cultural paradox. There is a growing commitment by tribes to address this problem and to provide and honor the Native American elder. This article provides information for health care providers to better understand elder abuse in the cultural context of the Native American community as well implications for care.

Knowledge and health beliefs related to heart disease risk among adults with type 2 diabetes

Purpose The purpose of this descriptive correlational study was to describe knowledge of cardiovascular disease (CVD) risk and to explore relationships between this knowledge and health beliefs and adherence among adults with type 2 diabetes. Data sources A convenience sample of 212 adults with type 2 diabetes completed the Heart Disease Fact Questionnaire and the health beliefs related to CVD Scale. Conclusions Knowledge was high for the majority of the sample. Deficits included the link between cholesterol and heart disease; CVD risk factors; and exercises for lowering CVD risk. Significant between-group differences occurred across education level (p = .021) and race (p = .045); participants with less education and who were Hispanic had the lowest knowledge scores. Among the health belief model variables, knowledge was only a significant predictor of perceived benefits (p = .033) and barriers (p = .00). The most common sources of information about diabetes and CVD were TV/radio/magazine/newspaper, healthcare providers, and patient education brochures, with substantially less exposure to CVD information. Implications for practice This study identified content to emphasize in interventions to improve awareness of CVD risk among adults with diabetes. Hispanic patients and those with low education levels are particularly in need of interventions appropriate to their education level and cultural orientation.PurposeThe purpose of this descriptive correlational study was to describe knowledge of cardiovascular disease (CVD) risk and to explore relationships between this knowledge and health beliefs and adherence among adults with type 2 diabetes. Data sourcesA convenience sample of 212 adults with type 2 diabetes completed the Heart Disease Fact Questionnaire and the health beliefs related to CVD Scale. ConclusionsKnowledge was high for the majority of the sample. Deficits included the link between cholesterol and heart disease; CVD risk factors; and exercises for lowering CVD risk. Significant between‐group differences occurred across education level (p = .021) and race (p = .045); participants with less education and who were Hispanic had the lowest knowledge scores. Among the health belief model variables, knowledge was only a significant predictor of perceived benefits (p = .033) and barriers (p = .00). The most common sources of information about diabetes and CVD were TV/radio/magazine/newspaper, healthcare providers, and patient education brochures, with substantially less exposure to CVD information. Implications for practiceThis study identified content to emphasize in interventions to improve awareness of CVD risk among adults with diabetes. Hispanic patients and those with low education levels are particularly in need of interventions appropriate to their education level and cultural orientation.

Comparing student clinical self-efficacy and team process outcomes for a DEU, blended, and traditional clinical setting: A quasi-experimental research study

BACKGROUND Clinical education is vital to both the development of clinical self-efficacy and the integration of future nurses into health care teams. The dedicated education unit clinical teaching model is an innovative clinical partnership, which promotes skill development, professional growth, clinical self-efficacy, and integration as a team member. Blended clinical teaching models are combining features of the dedicated education unit and traditional clinical model. OBJECTIVES The aims of this study are to explore how each of three clinical teaching models (dedicated education unit, blended, traditional) affects clinical self-efficacy and attitude toward team process, and to compare the dedicated education unit model and blended model to traditional clinical. METHODS A nonequivalent control-group quasi-experimental design was utilized. The convenience sample of 272 entry-level baccalaureate nursing students included 84 students participating in a dedicated education unit model treatment group, 66 students participating in a blended model treatment group, and 122 students participating in a traditional model control group. Perceived clinical self-efficacy was evaluated by the pretest/posttest scores obtained on the General Self-Efficacy scale. Attitude toward team process was evaluated by the pretest/posttest scores obtained on the TeamSTEPPS® Teamwork Attitude Questionnaire. RESULTS All three clinical teaching models resulted in significant increases in both clinical self-efficacy (p=0.04) and attitude toward team process (p=0.003). Students participating in the dedicated education unit model (p=0.016) and students participating in the blended model (p<0.001) had significantly larger increases in clinical self-efficacy compared to students participating in the traditional model. CONCLUSIONS These findings support the use of dedicated education unit and blended clinical partnerships as effective alternatives to the traditional model to promote both clinical self-efficacy and team process among entry-level baccalaureate nursing students.

Evaluating if patient self-perceptions of competencies have an influence on biological indicators for cardio-metabolic health

The purpose of this retrospective exploratory study was to evaluate how two important aspects of Banduras theory, conviction of the importance of the behavior, and the self-efficacy to perform the behavior, motivates an individual to change or improve life style behaviors.