Yaacov G. Bachner

Reliability generalization of responses by care providers to the Zarit Burden Interview

The Zarit Burden Interview (ZBI) is believed to be the most commonly used measure of caregiver burden. Originally developed more than 20 years ago for use with informal caregivers of community dwelling persons with Alzheimer disease, it has subsequently been administered to a diverse range of patient populations, formal or paid caregivers, and translated into numerous languages. Given that the ZBI is now used more broadly than it was initially intended and first validated, the current study applies the reliability generalization meta-analytic procedure to examine the psychometric properties of responses to the ZBI across populations. Multiple regression with categorical variables was performed to identify factors associated with error variance in ZBI reliability estimates (N=138 data points). Number of items, residence of the care recipient (community) and the Hebrew version each contributed significantly to prediction of internal consistency. These differences, however, were found to be relatively small and within accepted parameters. Generally, responses to the ZBI appear reliable across populations of caregivers and patients. Only versions of the ZBI with more or less than 22-items (nonstandard formats) reflect both statistical and meaningful differences in reliability. Where feasible, it is recommended that the 22-item version of the ZBI be used in future research and clinical practice.

Internal or external whistleblowing: Nurses’ willingness to report wrongdoing

In Israel, whistleblowing in the nursing profession has been largely ignored. This topic is neither part of the professional—ethical discourse nor a subject for research. Focusing on the divide between internal and external whistleblowing, this article presents a study that explores nurses’ willingness to disclose an act that could jeopardize the rights or safety of patients. Internal disclosure entails reporting wrongdoing to an authority within the organization. External disclosure involves reporting the offense to an outside agency, such as a professional organization or the press. The study’s findings indicate that the nurse respondents viewed both the harmful misconduct of a colleague and that of a manager as being very serious. In such dilemmas the nurses reported a desire to correct the wrongdoing and a concomitant willingness to act. They were, however, much more likely to whistleblow internally rather than externally. This study revealed a pattern of nurses’ progressive retraction as the circle of disclosure widened.

Meaning in Life: Does It Play a Role in Smoking?

The aim of this study was to investigate whether a relationship exists between a decreased level of meaning in life and smoking. In 2006, 341 Hungarian respondents (48.1% males, 51.9% females) completed a questionnaire that included the Purpose in Life test, a shortened version of the Aspiration Index and the Beck Depression Inventory, as well as questions about sociodemographic characteristics, past year alcohol and illicit drug consumption, and smoking behavior. The mean age of the participants was 33.0 years (SD = 14.6), while the average years of education of the respondents was 14.5 (SD = 2.7). According to the results of the regression analysis, meaning in life proved to be significant in differentiating between nonsmokers and daily smokers. With regard to the nonsmoker vs. occasional smoker and the daily vs. occasional smoker relationship, level of life meaning was not a significant predictor. The gender-meaning in life interaction was insignificant in all three relations. Limitations of this explorative investigation are noted.

Mortality communication as a predictor of psychological distress among family caregivers of home hospice and hospital inpatients with terminal cancer

Terminally ill cancer patients and their caregivers experience significant difficulties discussing illness and impending death (herein defined as mortality communication). The current study compares response levels as well as patterns of association between mortality communication and psychological distress among caregivers of home hospice and hospital inpatients. For this study, 231 family caregivers were recruited within a year of bereavement from the south and central health regions of Israel. Contrary to our initial hypothesis, retrospectively reported levels of mortality communication did not differ between groups; however, lower levels of depressive symptomatology were reported by home hospice caregivers. Separate path analytic models indicate statistically significant inverse associations between mortality communication and psychological distress (i.e. depressive symptomatology, emotional exhaustion). Invariance analyses indicate that the strength of association between variables did not differ between path models. The results of this study are discussed in terms of self-selection biases and possible confounds associated with retrospective reporting among bereaved caregivers.

Relationship between meaning in life and smoking status: Results of a national representative survey

Very little is known about the association between cigarette use and perceived level of meaning in life, although the connection of other addictive behaviors with the feeling of meaninglessness has been widely investigated. The aim of the present study was to examine the relationship between life meaning and smoking status in a large national representative sample. A total of 12,643 people were interviewed in the Hungarostudy 2002 survey, representing the Hungarian population according to gender, age, and sub-regions of the country. Multinomial logistic regression analysis showed that meaning in life scores significantly differentiated between current and never smokers, as well as between current and former smokers. In addition, the difference in life meaning scores between never and ex-smokers was insignificant, and gender did not interact with life meaning in relation to smoking status. Further research is needed to clarify the nature and mediators of the observed relationship between life meaning and smoking in order to better understand the role of existential concerns in cigarette use.

A cross-national comparison of reminiscence functions between Canadian and Israeli older adults

OBJECTIVES Recently, a model of reminiscence and well-being has emerged in which reminiscence functions have been shown to predict both the mental and physical health of middle-aged and older adults. Yet this model has thus far been verified only with North American, Western European, and Australian participants. This study was undertaken to compare the latent structure of responses between Canadian and Israeli older adults to ascertain if 8 distinct reminiscence functions map onto 3 second-order factors which, in turn, contribute significantly to measurement of an overarching reminiscence latent construct. METHOD For this study, 336 English Canadian and 206 Jewish Israeli adults more than 49 years of age provided responses for this study via an Internet website constructed specifically for this study. RESULTS Our findings demonstrate the psychometric equivalence as well as various cross-cultural differences in the relative strength of association between latent constructs (boredom reduction, bitterness revival, identity, and the overall contribution of self-negative functions to overall reminiscence). DISCUSSION We discuss various historical and geo-political factors that may account for these differences. For instance, recurrent war, ongoing terror, and regional instability make living and aging in Israel distinct from Canada. This model of reminiscence functions would appear sufficiently sensitive to capture cross-national differences.

Initial examination of the psychometric properties of the short Hebrew version of the Zarit Burden Interview

Objectives: Given the sharp increase in individuals with cognitive and physical impairments, the evaluation of burden has become common in both caregiving research and clinical practice. The Zarit Burden Interview (ZBI) is the first and one of the most commonly used measures of caregiver burden. This study examines the psychometric properties and factor structure of a Hebrew version of Bédard et al.s [Bédard, M., Molloy, D.W., Squire, L., Dubois, S., Lever, J.A., & O’Donnell, M. (2001). The Zarit Burden Interview: A new short version and screening version. The Gerontologist, 41, 652–657] short ZBI scale (ZBI-HS). Methods: A total of 148 primary caregivers of individuals with cognitive and/or physical impairments completed the ZBI-HS. The factor structure of the ZBI-HS was assessed using exploratory factor analysis (EFA) and concurrent validity was examined. Results: The EFA supported the two-factor structure as reported by Bédard et al. (2001). Concurrent validity was supported by the ZBI-HS negative association with caregivers’ well-being and positive association with caregivers’ distress over behavioral problems of care-recipients. Conclusion: These findings suggest that the short version of the ZBI-HS can be used as an effective tool for measuring caregiving burden.

Self‐Reported Likelihood of Whistleblowing by Social Work Students

This article presents a first study on the professional–ethical dilemma of whistleblowing in social work, and suggests some lines for further research on this topic as well as ways for integrating it in the social work curriculum. The study examines the self‐reported readiness of social work students to blow the whistle, whether internally or externally. Internal disclosure entails reporting the wrongdoing to an authority within the organization. External disclosure entails reporting the offense to an outside agency, such as the police, professional organization, or press. The findings indicate that the students view the acts that are detrimental or cause injustice to the client in a very serious light. In dilemma situations such as these, the students reported a willingness to act. The students also report considerably greater likelihood of whistleblowing internally than externally.

Can achievement goal theory provide a useful motivational perspective for explaining psychosocial attributes of medical students

BackgroundPsychosocial competence and frustration tolerance are important characteristics of skilled medical professionals. In the present study we explored the usefulness of applying a comprehensive motivational theory (Goal orientations), for this purpose. According to goal orientation theory, learning motivation is defined as the general goals students pursue during learning (either mastery goals - gaining new knowledge; or performance goals - gaining a positive evaluation of competence or avoiding negative evaluation). Perceived psychosocial abilities are a desirable outcome, and low frustration tolerance (LFT), is a negative feature of student behavior. The hypothesis was that the mastery goal would be positively associated with psychosocial abilities while performance goals would be positively associated with LFT.Methods143 first-year medical students completed at the end of an annual doctor-patient communication course a structured questionnaire that included measures of learning goal orientations (assessed by Pattern of Adaptive Learning Scale - PALS), psychosocial abilities (assessed by Psychological Medicine Inventory- student version -PMI-S) and Low Frustration Tolerance (LFT).ResultsAll study variables were found reliable (Cronbachs α ranged from .66 to .90) and normally distributed. Hierarchical multiple regression analysis revealed significant associations supporting the hypotheses. The mastery goal orientation was positively associated with perceived psychosocial abilities (PMI-S) (β = .16, p < .05) and negatively associated with low frustration tolerance (β = -.22, p < .05) while performance goal orientation was significantly associated with low frustration tolerance (β = .36, p < .001).ConclusionsThe results suggest that the goal orientations theory may be a useful theoretical framework for understanding and facilitating learning motivation among medical students. Limitations and suggestions for practice within medical education context are discussed.

Examining the Social Context in the Caregiving Experience: Correlates of Global Self-Esteem Among Adult Daughter Caregivers to an Older Parent With Cancer

Objectives: To examine the associations between various patient, disease, situation, and caregiver characteristics (organized by five conceptual domains) and global self-esteem among caregiver daughters to parents with cancer. Method: Dyads comprised of 237 cancer outpatients and their adult caregiving daughter completed structured telephone interviews. Results: Two of the five domains of potential correlates significantly predicted caregiving daughters’ global self-esteem—daughters’ sociodemographics and constraints on/facilitators of caregiving. Daughters’ overall sense of self-worth was directly correlated with their household income and inversely correlated with greater depressive affect and the number of patient needs for which someone else provided assistance. It was also correlated with the daughters’ other role obligations. A higher sense of self-worth was associated with either being employed or having to care for a child/grandchild; a lower sense of self-worth was associated with having a spouse/partner. Discussion: The present analysis documents the complexity of social connectedness, demonstrating that various role obligations contribute to caregiving daughters’ global self-esteem in different ways. In the context of assuming cancer careprovision, daughters’ existing repertoire of social roles may possibly mediate the stress associated with their care involvement or serve as a buffer against the strain of the caregiving experience.