Richard Zeller

Minimizing sample size when using exploratory factor analysis for measurement.

Traditional protocol for the determination of an adequate sample size is power analysis. Such a protocol is not useful when the primary hypothesis focuses on psychometric measurement properties. Traditional psychometrics advises that there should be 10 respondents per item. Both hypothetical and real research examples illustrate the usefulness of sub-sample analysis in determining that a sample size of at least 50 and not more than 100 subjects is adequate to represent and evaluate the psychometric properties of measures of social constructs. The “10 respondents per item” advice builds a sample size disincentive into the research design; it also represents “sample size overkill.” Sample-size overkill occurs when the research design specifies a number of cases needed, which is in excess of the number actually needed for a desired inference.

Depression, stress, emotional support, and self-esteem among baccalaureate nursing students in Thailand.

Nursing students are valuable human resources. Detection of potential depression among nursing students is crucial since depression can lead to low productivity, minimized quality of life, and suicidal ideas. Identifying factors affecting depression among students can help nursing educators to find ways to decrease depression. The purpose of this study was to examine rates of depression and the associations between depression and stress, emotional support, and self-esteem among baccalaureate nursing students in Thailand. This correlational, cross-sectional study recruited 331 baccalaureate Thai nursing students. Students completed three instruments that had been translated into Thai: The Center for Epidemiology Studies Depression Scale, Perceived Stress Questionnaire, and Rosenberg Self-Esteem Scale. Another instrument created in Thai was used to measure emotional support. Results revealed that, when using the standard definition, 50.1% of the students were depressed. Stress was positively related to depression, whereas emotional support and self-esteem were negatively related to depression.

DXA, Health Beliefs, and Osteoporosis Prevention Behaviors

Objective: This experimental longitudinal study was designed to examine the relationship between having a bone density through dual energy X ray absorptiometry (DXA) and osteoporosis preventing behaviors (OPB) among healthy postmenopausal women. Methods: Subjects were 203 healthy community-based women 50-65 years of age. Mediating variables were general knowledge of osteoporosis and revised health belief model variables. Treatment group women (n = 101) had a DXA screen and control group women (n = 102) did not. Study questionnaires were completed at three time points; initially and at 6 months and 12 months. Results: Repeated measures ANOVA revealed treatment group women scored significantly higher on perceived susceptibility and calcium intake. Wilkss Lambda F revealed a significant difference in use of osteoporosis preventing medications. Discussion: Personal knowledge gained from DXAs increased perceived susceptibility to osteoporosis, calcium intake, and use of osteoporosis preventing medications and appears to be an effective intervention in promoting OPB in younger postmenopausal women.

An Improved Methodology for Advancing Nursing Research Factorial Surveys

Clinical judgments and decisions are an integral component of nurse work and nurses are increasingly being challenged to account for their judgments and decisions. Nursing research is needed to help explain judgment and decision making in nursing, but most research in this area is almost exclusively characterized by descriptive studies. This article describes the use of the factorial survey method, which combines the explanatory power of a factorial experiment with the benefits of a sample survey. This hybrid technique is an excellent method for studying judgments and decisions across settings, roles, disciplines, and countries. This article outlines the steps of the method and demonstrates its applicability with an exemplar from a study across nurses from 3 countries.

Development and Testing of a Measure of Perceived Caregiver Rewards in Adults

Assessment of the rewards of caregiving is pertinent to a holistic view of the caregiving experience and design of health promotion interventions for caregivers. Few measures of caregiver positive appraisals exist. This paper describes the development and pilot testing of the Picot Caregiver Rewards Scale (PCRS) for adult caregivers. Derived from the choice and social exchange theory, caregiver interviews, and literature, 25 items compose the scale. Psychometric testings of the PCRS were conducted in a nonrandom sample of 83 Black female caregivers and a random sample of 256 Black and White female and male caregivers. Alphas of .83 and .88 demonstrated acceptable internal consistency of the revised 16-item PCRS. Construct validity was demonstrated by support of hypothesized relationships with caregiving demands, palliative coping, depression, and caregiver burden, as well as confirmatory factor analysis. Further psychometric study of the PCRS is recommended.

The Humpty Dumpty Falls Scale: A Case–Control Study

PURPOSE The purpose of this descriptive study was to assess whether the Humpty Dumpty Falls Scale (HDFS) identifies hospitalized pediatric patients at high risk for falls. DESIGN AND METHODS The study was a matched case-control design. A chart review of 153 pediatric cases who fell and 153 controls who did not fall were pair-matched by age, gender, and diagnosis. RESULTS High-risk patients fell almost twice as often as low-risk patients (odds ratio 1.87, confidence interval = 1.01, 3.53, p = .03). PRACTICE IMPLICATIONS A Falls Prevention Pediatric Program with the HDFS tool addresses the Joint Commission Patient Safety Goals, but further research is needed to examine HDFS sensitivity-specificity.

Depressive Symptoms Among HIV‐Positive Pregnant Women in Thailand

PURPOSE To examine predictors of depressive symptoms among human immunodeficiency virus (HIV)-positive, pregnant women in Thailand. DESIGN Correlational, cross-sectional study. METHODS Data were collected at prenatal clinics in five hospitals in Thailand from January 2004 to January 2006. One hundred twenty-seven HIV-positive pregnant women completed questionnaires in Thai on depressive symptoms, self-esteem, emotional support, physical symptoms, and demographics. Simultaneous multiple regression was used to analyze predictors of depressive symptoms. FINDINGS Seventy-eight percent of the 127 participants reported depressive symptoms to some degree. Physical symptoms (beta= .192, p<.05) were positively associated with depressive symptoms, but self-esteem (beta=-.442, p<.001), emotional support (beta=-.193, p<.01), and financial status (beta=-.209, p<.01) were negatively correlated with depressive symptoms. CONCLUSIONS The study results have added new knowledge about depressive symptoms and their predictors in HIV-positive pregnant women in Thailand. CLINICAL RELEVANCE Depressive symptoms have been associated with faster progression to acquired immunodeficiency syndrome among HIV-positive individuals. The high rate of depression in our study suggests that HIV-positive pregnant women in Thailand should all be screened for depressive symptoms. Causes of physical symptoms should be identified and treated. Emotional support and self-esteem should be strengthened for HIV-positive pregnant Thai women.

Depressed patients understand heart failure prognosis but not how to control it

BACKGROUND Depression prevalence in patients with heart failure (HF) is 21% to 42%. Conceptual illness beliefs that patients have about HF may be associated with depression. METHODS We examined whether accuracy of illness beliefs was associated with depression. Illness belief scores were compared with depression severity, and multivariable analyses were performed to determine factors that were independently associated with depression. RESULTS In 219 elderly patients with HF, depression prevalence was 47%. Accuracy of illness beliefs was associated with depression (r = .224; P = .049), due solely to accuracy of beliefs about consequences of HF (P = .005). Beliefs about how to control HF remained stable as depression severity increased. After controlling for significant univariable factors, mean illness belief and consequence scores remained associated with depression. CONCLUSION In this sample, accuracy of beliefs about HF consequences increased but beliefs about how to control HF remained unchanged as depression severity worsened. This combination of HF beliefs may influence coping through self-care behaviors.

Self-esteem, parent-child interaction, emotional support, and self-perception among Thai undergraduate nursing students.

The purpose of this study was to examine the effect of parent-child interaction on self-esteem as mediated by emotional support and self-perception among undergraduate nursing students in Thailand. This study recruited 307 Thai baccalaureate nursing students who completed the Rosenberg Self-Esteem Scale, Ross Parent-Child Interaction Questionnaire, Emotional Support instrument, and Self-Perception questionnaire. Results revealed that the students reported relatively high self-esteem. A path model demonstrated the positive effect of parent-child interaction on emotional support and self-perception, and the positive effects of emotional support and self-perception on self-esteem. Self esteem was powerfully predicted from emotional support and moderately predicted from self-perception. These variables account for 37% of the variance in self esteem.

Alcohol use in women 65 years of age and older

The purpose of this study was to examine the relationships between depression, codependency, self-coherence, and alcohol use and health outcomes in women 65 years of age and older. The framework is Eriksons ego-development theory. A convenience sample of 238 women was obtained from women attending flu shot clinics. This cross-sectional field study used survey methodology. Measures included the Beck Depression Inventory, Codependency Assessment Tool, Self-Coherence Survey Form C, Alcohol Use Disorders Identification Test, Alcohol Use Questionnaire, Self-Rated Health Tool, Quality of Life Visual Analogue Scale, Functional Ability Scale, Illness Prevention Screening Behaviors Checklist, and Sociodemographic Data. Results indicate a low consumption and little variation in use of alcohol. There were no significant associations between alcohol consumption and the dependent variables. Depression was significantly related to all the health outcomes; codependency was significantly related to all health outcomes except perceived quality of life; and self-coherence was significantly related to all health outcomes except illness prevention behavior. These findings have important implications for those providing care for older women.The purpose of this study was to examine the relationships between depression, codependency, self-coherence, and alcohol use and health outcomes in women 65 years of age and older. The framework is Eriksons ego-development theory. A convenience sample of 238 women was obtained from women attending flu shot clinics. This cross-sectional field study used survey methodology. Measures included the Beck Depression Inventory, Codependency Assessment Tool, Self-Coherence Survey Form C, Alcohol Use Disorders Identification Test, Alcohol Use Questionnaire, Self-Rated Health Tool, Quality of Life Visual Analogue Scale, Functional Ability Scale, Illness Prevention Screening Behaviors Checklist, and Sociodemographic Data. Results indicate a low consumption and little variation in use of alcohol. There were no significant associations between alcohol consumption and the dependent variables. Depression was significantly related to all the health outcomes; codependency was significantly related to all health outcomes except perceived quality of life; and self-coherence was significantly related to all health outcomes except illness prevention behavior. These findings have important implications for those providing care for older women.