Steven La Grow

Researching moral distress among New Zealand nurses A national survey

Background: Moral distress has been described as a major problem for the nursing profession, and in recent years, a considerable amount of research has been undertaken to examine its causes and effects. However, few research projects have been performed that examined the moral distress of an entire nation’s nurses, as this particular study does. Aim/objective: The purpose of this study was to determine the frequency and intensity of moral distress experienced by registered nurses in New Zealand. Research design: The research involved the use of a mainly quantitative approach supported by a slightly modified version of a survey based on the Moral Distress Scale–Revised. Participants and research context: In total, 1500 questionnaires were sent out at random to nurses working in general areas around New Zealand and 412 were returned, giving an adequate response rate of 27%. Ethical considerations: The project was evaluated and judged to be low risk and recorded as such on 22 February 2011 via the auspices of the Massey University Human Ethics Committee. Findings: Results indicate that the most frequent situations to cause nursing distress were (a) having to provide less than optimal care due to management decisions, (b) seeing patient care suffer due to lack of provider continuity and (c) working with others who are less than competent. The most distressing experiences resulted from (a) working with others who are unsafe or incompetent, (b) witnessing diminished care due to poor communication and (c) watching patients suffer due to a lack of provider continuity. Of the respondents, 48% reported having considered leaving their position due to the moral distress. Conclusion: The results imply that moral distress in nursing remains a highly significant and pertinent issue that requires greater consideration by health service managers, policymakers and nurse educators.

The role of hope in adjustment to acquired hearing loss

This study investigated the relationship between individual and disability characteristics and adjustment to acquired hearing loss, and the role hope has in that relationship. A sample of 114 adults with sensorineural hearing loss who had accessed hearing therapy services participated in the study. The mean age of the participants was 67 years. A survey of individual and disability characteristics, hope and adjustment was conducted. Multiple regression analyses were applied to examine possible moderating and mediating models. The results indicate that the degree of loss was the only statistically significant individual and disability characteristic related to adjustment. The trait of hope was found to serve as a mechanism by which the degree of loss affects adjustment. Hearing loss affects hope which in turn affects adjustment. Hope was found to account for 45% of the relationship between the degree of loss and adjustment. Additionally, the study found that self-efficacy and personal meaning may influence hope and despair dimensions in different ways. Discussion centres on the implication of these findings for intervention strategies used in rehabilitation programmes for those with a significant hearing loss.

Mobility, satisfaction with functional capacity and perceived quality of life (PQOL) in older persons with self-reported visual impairment: The pathway between ability to get around and PQOL

Abstract Background: Research shows that ability to get around (AGA) is significantly associated with perceived quality of life (PQOL) among older persons with self-reported visual impairment. Much of this impact, however, is through satisfaction with one’s functional capacity. Satisfaction with functional capacity is a construct composed of five items: satisfaction with (1) activities of daily living, (2) capacity to work, (3) self, (4) health and (5) sleep. At present, it is not known how AGA interacts individually with these items to influence PQOL. Purpose: The purpose of this study is to investigate the extent to which AGA interacts with each of these five items to affect PQOL. Methods: Structural equation modelling was employed in a secondary-analysis of data from 356 persons (aged 56–72) with self-reported visual impairment to identify the pathways by which AGA affects PQOL. Results: Satisfaction with self and health were the only items found to be both directly related to QOL and to provide a significant pathway between AGA and PQOL. Conclusion: AGA significantly affects PQOL both directly and indirectly through its impact on people’s satisfaction with self and health. Lessons may be learnt from this to better focus mobility interventions to enhance PQOL in this population. Implications for Rehabilitation The findings of this study indicate that ability to get around (AGA) has a significant impact on perceived quality of life (PQOL): the stated goal of many rehabilitation programs for older persons who are visually impaired. The study also found that the primary pathway by which AGA influenced PQOL was indirect through its association with both satisfaction with one’s self and health rather than direct. Attempts to enhance PQOL by increasing AGA may be most effective if the focus of intervention was on restoring one’s sense of self and health as opposed to focusing on meeting practical needs.

An Investigation of the Complexities of Successful and Unsuccessful Guide Dog Matching and Partnerships

Matching a person who is blind or visually impaired with a guide dog is a process of finding the most suitable guide dog available for that individual. Not all guide dog partnerships are successful, and the consequences of an unsuccessful partnership may result in reduced mobility and quality of life for the handler (owner), and are costly in time and resources for guide dog training establishments. This study examined 50 peoples’ partnerships with one or more dogs (118 pairings) to ascertain the outcome of the relationship. Forty-three of the 118 dogs were returned to the guide dog training establishment before reaching retirement age, with the majority (n = 40) being categorized as having dog-related issues. Most (n = 26) of these dogs’ issues were classified as being behavioral in character, including work-related and non-work-related behavior, and 14 were due to physical causes (mainly poor health). Three dogs were returned due to matters relating to the handlers’ behavior. More second dogs were returned than the handlers’ first or third dogs, and dogs that had been previously used as a guide could be rematched successfully. Defining matching success is not clear-cut. Not all dogs that were returned were considered by their handlers to have been mismatched, and not all dogs retained until retirement were thought to have been good matches, suggesting that some handlers were retaining what they considered to be a poorly matched dog. Almost all the handlers who regarded a dog as being mismatched conceded that some aspects of the match were good. For example, a dog deemed mismatched for poor working behavior may have shown good home and/or other social behaviors. The same principle was true for successful matches, where few handlers claimed to have had a perfect dog. It is hoped that these results may help the guide dog industry identify important aspects of the matching process, and/or be used to identify areas where a matching problem exists.

Individual Rehabilitation Plans, Goals and Outcomes: An Argument for Utilizing Individually Determined Outcome Measures in Rehabilitation

The advent of managed care as a system driving purchasing in the health sector has brought with it an emphasis on purchasing outcomes rather than inputs. Although any change in purchasing schemes will have an effect on service providers, it should not prove to be too disruptive for those of us in rehabilitation since rehabilitation as a service system has always been outcome driven. In fact, our entire system is driven by needs based assessment and directed toward the meeting individually identified goals for service. These goals reflect the desired outcome of the service we provide for each individual served. The challenge we face, then, is translating our emphasis on goal directed, outcome driven services to meet the language, understanding and expectations of our funding agents as they begin to adopt a regime of outcome based contracts. The purpose of this paper is to argue the validity of individually determined outcomes as opposed to institutionally determined measures and to propose one method of measuring those outcomes in a manner that is applicable to the needs of the purchaser.

Health, functional ability and life satisfaction among older people 65 years and over: a cross-sectional study

Background: Satisfaction with life is a complex interplay of older people’s perspectives on life achievements. Satisfaction with life, alongside health and functional ability contribute to successful ageing. Aim: To explore the impact of increasing age on older people’s perceptions of their health, functional ability and life satisfaction. Methods: A cross-sectional survey of non-institutionalised older people (65+) was conducted (n = 542). The Short Form-12 Health Survey measured perceived physical and mental health, the Groningen Activity Restriction Scale measured functional ability and the Satisfaction With Life Scale measured life satisfaction. Results: Significant group differences were found; while participants’ perceptions of health and function decreased with age, perceptions of life satisfaction increased. Unexpectedly, the youngest groups reported low levels of life satisfaction while the oldest reported very high levels. Conclusions: Further study should consider factors that might influence the perception of health, functional ability and particularly life satisfaction across older age groups.

Development of the Difficulty with Mobility Questionnaire: A Pilot Study

A 23-item diffi culty with mobility questionnaire (DMQ) was piloted with 32 persons who had participated in a one-week orientation and mobility (O&M) course offered by Guide Dogs Queensland in early 2014 to determine its potential utility as an outcome measure for O&M instruction. The DMQ was assessed for reliability, validity, and sensitivity. Reliability was established using Cronbach’s alpha coeffi cient. Validity was assessed by determining the extent to which the total diffi culty score correlated with a single-item global measure of ability to get around. Sensitivity of each of the diffi culty items to refl ect change following completion of the course was assessed by comparing pretreatment to post-treatment scores using paired samples t-tests. Acceptable levels of reliability, validity, and sensitivity were demonstrated.