Vaughn G. Sinclair

The Development and Psychometric Evaluation of the Brief Resilient Coping Scale

This article introduces the Brief Resilient Coping Scale (BRCS), a 4-item measure designed to capture tendencies to cope with stress in a highly adaptive manner. Two samples of individuals with rheumatoid arthritis (ns = 90 and 140) provide evidence for the reliability and validity of the BRCS. The BRCS has adequate internal consistency and test-retest reliability. Convergent validity of the scale is demonstrated by predictable correlations with measures of personal coping resources (e.g., optimism, helplessness, self-efficacy), pain coping behaviors, and psychological well-being. Resilient coping, as assessed by the BRCS, also buff-ers the effects of high levels of arthritis-related and non-arthritis-related stressors on depressive symptoms. The sensitivity of the BRCS to changes associated with a cognitive-behavioral intervention is also demonstrated. The BCRS may be useful for identifying individuals in need of interventions designed to enhance resilient coping skills.

Voices from the shadows: living with lymphedema.

Background:Breast cancer survivors with lymphedema face a lifetime of stressful physical and emotional symptoms and challenging self-care demands. An in-depth understanding of the perceptions and feelings surrounding life with lymphedema is critical to developing effective supportive care approaches. Objective:The objective of the study was to explore perceptions and feelings related to lymphedema in breast cancer survivors. Method:The expressive writings of 39 individuals were evaluated for this descriptive qualitative study. Data were analyzed using conventional content analysis. Results:Qualitative analyses produced 4 major themes: (1) marginalization and minimization, (2) multiplying losses, (3) yearning to return to normal, and (4) uplifting resources. Subthemes for each major theme were also identified. Conclusion:The lymphedema experiences of breast cancer survivors reveal perceptions of marginalization from healthcare providers who are not well informed about lymphedema management and minimizing its impact. Multiple distressing losses confront these patients on a daily basis, including body image disturbances, loss of functionality and control over time, permanent uncertainty, and adverse effects on relationships. The daily challenges of lymphedema often result in cumulative frustration and resentment that contribute to failure to perform self-care. Normalcy has been lost, never to return. These women find solace, encouragement, and hope to meet the challenges of lymphedema through support from others and their spiritual beliefs. Implications for Practice:Healthcare providers need greater awareness of the physical and psychosocial effects of lymphedema in breast cancer survivors. Nurses have unique opportunities to serve as advocates for reducing perceived marginalization and promoting effective self-care and other activities that promote psychological well-being and reduce physical deterioration.

Effects of a cognitive–behavioral intervention for women with rheumatoid arthritis

The purpose of this quasi-experimental study was to evaluate the effectiveness of a cognitive-behavioral nursing intervention for women with rheumatoid arthritis (RA). Ninety adult women with RA participated in 1 of 14 nurse-led groups over an 18-month period. Personal coping resources, pain-coping behaviors, psychological well-being, and disease symptomatology were measured at four time periods. There were significant changes on all of the measures of personal coping resources (p < .001) and psychological well-being (p < .05), half of the pain-coping behaviors (p < .05), and one indicator of disease symptomatology (fatigue, p < .05) from pre- to postintervention. Furthermore, the positive changes brought about by the program were maintained over the 3-month follow-up period. The intervention may be adapted to benefit individuals with a variety of stressful medical conditions.

Development and validation of the Emotional Intimacy Scale.

Although many measures have been developed to capture elements of social support, only a few include an assessment of emotional intimacy. Emotional intimacy involves a perception of closeness to another that allows sharing of personal feelings, accompanied by expectations of understanding, affirmation, and demonstrations of caring. The 5-item Emotional Intimacy Scale (EIS) was developed to assess the emotional intimacy component in one close relationship. A sample of 90 women with rheumatoid arthritis was used to assess the reliability and validity of the scale. Internal consistency and test-retest reliability for a 6-week period were .88 and .85, respectively. To assess construct validity, significant, positive correlations were obtained between the EIS and measures of social support, self-efficacy, perceived health competence, reappraisal coping behaviors, life satisfaction, and positive affect. Significant negative correlations were obtained between the EIS and perceived stress levels, helplessness, negative pain coping behaviors, pain, and fatigue. In support of criterion-related validity, the EIS predicted outcomes from an intervention program. To further assess criterion-related validity, scores on the EIS and helplessness predicted scores on two indicators of psychological well-being that measured positive affect and life satisfaction. The EIS is a brief measure of emotional intimacy with good psychometric properties.

Predictors of improvement in a cognitive-behavioral intervention for women with rheumatoid arthritis.

In this article we present a secondary analysis of data from a brief cognitive—behavioral intervention for women with rheumatoid arthritis that resulted in significant overall improvements in personal coping resources, pain coping behaviors, psychological well-being, and fatigue. Not every participant, however, improved during the intervention. Establishing predictors of improvement in brief interventions is important to optimize the cost-effective use of these resources. In search of predictors of improvement, we examined demographic and background variables, personal coping resources, pain coping behaviors, and social support. Both linear and quadratic effects were analyzed, comparing baseline measures to both immediate postintervention and 3-month follow-up outcomes using standardized indexes of predictors and criteria variables. After removing the effects of baseline scores on the outcomes index, significant predictors of improvement included length of time since diagnosis, personal coping resources, and maladaptive and adaptive pain coping behaviors. Both linear and quadratic effects were found, although this varied as a function of type of predictor.

The development and validation of the Psychological Vulnerability Scale

The purpose of this article is to introduce thePsychological Vulnerability Scale (PVS), a six-itemmeasure of a set of cognitions that promote harmfulreactions to stress. Maladaptive cognitive reactions tointerpersonal events can affect coping behavior andpsychological and physical well-being. A measure ofpsychological vulnerability that reflects detrimentalcognitive beliefs could be valuable in identifyingindividuals most in need of cognitive-behavioralinterventions. Three samples (ns = 90, 138, and 137) ofindividuals with rheumatoid arthritis provide evidencefor the reliability and validity of the PVS, which has adequate internal consistency and test-retestreliability. Convergent validity of the scale isdemonstrated by positive correlations with measures ofperceived helplessness, negative affect, maladaptive pain coping behaviors, and disease activity,and negative correlations with measures of positiveaffect, life satisfaction, adaptive pain-copingbehaviors, perceived social support, and personal coping resources such as self-efficacy. Thesensitivity of the PVS to cognitive-behavioralintervention is also demonstrated.

Psychological Vulnerability Predicts Increases in Depressive Symptoms in Individuals With Rheumatoid Arthritis

Background:Efficient measures are needed to identify individuals at risk for depression to optimize intervention efforts that can enhance health-related outcomes. Objectives:The purpose of this study was to examine the effectiveness of the six-item Psychological Vulnerability Scale (PVS) as a predictor of depressive symptoms and change in depressive symptoms while controlling for two established predictors of depression-arthritis helplessness (AHI) and functional impairment (FI). Methods:Data from 125 patients with rheumatoid arthritis (73% women) were used in hierarchical regression analyses to examine whether the PVS could be used to predict unique variance in depressive symptoms (Center for Epidemiological Studies-Depression [CES-D]) cross sectionally (N = 125) and change in depressive symptoms (N = 93). Results:The three-predictor cross-sectional model was highly significant, F(3, 121) = 25.6; p < .001, explaining 39% of the variance in CES-D scores assessed at the same point in time. Controlling for both AHI and FI, the PVS explained an additional 9.3% of the variance in CES-D scores. To examine changes in CES-D scores over a 1-year period, CES-D scores at the later time were regressed on CES-D scores from a year earlier. On the next two steps, AHI, FI, and PVS scores assessed a year earlier were entered into the model. The full model predicted 56% of the variance in depressive symptoms, F(4, 88) = 27.7, p < .001, with the PVS accounting for a unique 5.6% of the variance in change in CES-D scores. Discussion:Because of its brevity, the PVS can be an efficient screening tool for individuals at risk for depression. More research is needed to substantiate the value of the PVS for identifying individuals who could benefit from interventions designed to prevent depression.

Breast Cancer Survivors With Lymphedema

Breast cancer survivors with lymphedema experience physical, psychosocial, and quality-of-life difficulties. Cancer treatment-related lymphedema often is viewed as a disabling condition, and that assumption has fostered an environment in which oncology nurses are not actively involved in the care of patients with lymphedema. Little is known about how breast cancer survivors with lymphedema structure their daily lives. This article describes an effort to determine whether lymphedema truly is a disabling condition by collecting symptom data and self-generated narratives from breast cancer survivors with lymphedema regarding their eating habits, daily activities, substance use, and future plans. Although the sample experienced multiple symptoms, lymphedema duration and degree of extracellular arm fluid did not appear to influence those symptoms. In addition, participants led full, rich, busy lives. The findings do not support the notion that patients with lymphedema live as disabled people. A disability model may not be optimal to guide research design or patient care; rather, a symptom management model better explains the findings and implies that active involvement by nurses in lymphedema patient care and education is indicated.

Evidence for validity of the brief resilient coping scale in a young Spanish sample.

The aim of the present study was to provide evidence of validity of the Brief Resilient Coping Scale for use in Spanish young population. A total of 365 university students responded to the Spanish version of the BRCS as well as to other tools for measuring personal perceived competence, life satisfaction, depression, anxiety, negative and positive affect, and coping strategies. Confirmatory factor analysis confirmed the unidimensional structure of the scale. Internal consistency reliability and temporal stability through Cronbachs alpha and test-retest correlations, respectively, were comparable to those found in the initial validation of the tool. The BRCS showed positive and significant correlations with personal perceived competence, optimism, life satisfaction, positive affect (p < .01), and some coping strategies (p < .05). Significant negative correlations were observed with depression, anxiety and negative affect. (p < .01). Multiple regression analysis with stepwise method showed that positive affect, negative affect, optimism and problem solving explained 41.8% of the variance of the BRCS (p < .001). The Spanish adaptation of the BRCS in a young population is satisfactory and comparable to those of the original version and with the Spanish version adapted in an elderly population. This supports its validity as a tool for the assessment of resilient coping tendencies in young people who speak Spanish and offers researchers and professionals interested in this area of study a simple tool for assessing it.

Breast cancer survivors’ perspectives of critical lymphedema self-care support needs

PurposeTo solicit breast cancer survivors’ perspectives on the variety of issues they face related to lymphedema self-care and identify support needs perceived as critical for managing their chronic medical condition.MethodsTwenty-one breast cancer survivors with lymphedema participated in audio-recorded focus groups about barriers and facilitators of self-care. Transcripts were analyzed using ATLAS.ti software by two coders. Triangulation of findings provided for refinement and category confirmation.ResultsThemes identified included lack of social support, lack of resources for self-care activities, and self-advocacy by default. Lack of social support subthemes were feeling misunderstood, minimization of needs, and feeling criticized. Lack of resources for self-care activities subthemes were lack of both tangible self-care support and self-care supplies. Self-advocacy by default subthemes were the need to proactively manage lymphedema complications, the need to educate health-care workers, and feeling marginalized by the health-care system.ConclusionsLack of support and the failure of others to recognize lymphedema as a chronic condition set this patient population apart from other patients with chronic diseases and decreases the amount of help needed to manage the condition.