Nursing Professional Capital: A Qualitative Analysis

OBJECTIVE: The objective of this study was to offer qualitative support for the assertion that nurses possess professional capital. BACKGROUND: Nurses embrace professional standards and tenets that have been measured as trust and ethics. By understanding forms of capital and combining quantitative public-opinion surveys and our qualitative findings, a case can be made that nurses possess professional capital. METHOD: This was a focused review of existing interview data and was conducted using inductive content analysis. FINDINGS: Patients provided unsolicited accounts of trust and positive regard for their nurses. CONCLUSION: Evidence supports that in combination with trust and positive regard, nurses possess professional capital. Nurses should judiciously use their professional capital to impact institutional, political, and economic policy

Are there gender, racial or relationship differences in caregiver task difficulty, depressive symptoms and life changes among stroke family caregivers?

OBJECTIVE: To examine differences in caregiver perceptions of task difficulty, depressive symptoms and life changes based on caregiver characteristics of gender, race and type of relationship to the person with stroke. METHODS: A sample of 243 stroke caregivers (females n = 191; males n = 52; non-African Americans n = 184; African Americans n = 59; non-spouses n = 127; spouses n = 116) were interviewed by telephone within 8 weeks of the survivor's discharge to home. Measures included the Oberst Caregiving Burden Scale (OCBS) for task difficulty, Patient Health Questionnaire (PHQ-9) for depressive symptoms and Bakas Caregiving Outcomes Scale (BCOS) for life changes. Three general linear models computed differences in OCBS, PHQ9 and OCBS scores. RESULTS: Significant differences were found on the OCBS for females (p < 0.001) and African American spouses (p < 0.048); on the PHQ9 for females (p < 0.001), non-African Americans (p = 0.047), spouses (p = 0.003) and African-American spouses (p = 0.010); and on the BCOS for females (p = 0.008) and non-African Americans (p = 0.033). CONCLUSIONS: Findings suggest that female and non-African American stroke caregivers are relatively more likely to experience task difficulty, depressive symptoms and negative life changes as a result of providing care. African American spouses were also at risk. Tailoring interventions based on caregivers' characteristics may improve outcomes

SYMPTOM CORRELATES OF CAREGIVER BURDEN IN SPOUSES OF PERSONS WITH DEMENTIA

poster abstractCaregiver burden is a key predictor of institutionalization of persons with dementia. Using the Lenz et al. (1997), Theory of Unpleasant Symptoms as a guide, the purpose of this study was to determine whether pain, fatigue, or depressive symptoms are associated with caregiver burden among spouses of persons with dementia. A secondary analysis of an existing database of a cross-sectional, descriptive study of 83 spouses of persons with dementia was conducted. Spouses were predominately female (60%) and Caucasian (76%) with a mean age of 77 years. Symptom data were collected using items from the SF-36v2. Burden data was collected using the abridged Zarit Burden Interview. Data were analyzed using descriptive, correlational, and multiple regression statistical analyses. Spouse caregiver pain, fatigue, and depressive symptoms were significantly associated with caregiver burde

Task difficulty and life changes among stroke family caregivers: relationship to depressive symptoms

OBJECTIVES: To investigate differences in stroke caregiver task difficulty and life changes based on level of caregiver depressive symptoms, and to estimate probabilities among task difficulty and life change items. DESIGN: Descriptive analysis of baseline data from an ongoing stroke caregiver intervention trial. SETTING: Hospitals and rehabilitation facilities. PARTICIPANTS: Caregivers (N=242; 78.6% women; 47.7% spouses; 71.8% white; mean age, 54.2±12.1y) caring for stroke survivors within 8 weeks of discharge to home. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Baseline measures for task difficulty (Oberst Caregiving Burden Scale) and life changes (Bakas Caregiving Outcomes Scale) were compared based on level of depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores <5 means no depressive symptoms; n=126; PHQ-9 scores ≥5 means mild to severe depressive symptoms, n=116). Mean scores were analyzed using general linear modeling, with item analyses using logistic regression and the Benjamini-Hochberg method to control type I error inflation. RESULTS: Caregivers with mild to severe depressive symptoms have greater difficulty with tasks and worse life changes than those with no depressive symptoms (P<.001). Odds ratios were highest for the task of arranging care while away and for negative life changes (eg, addressing self-esteem, coping with stress, physical health). CONCLUSIONS: Findings underscore the importance of depressive symptom screening for stroke caregivers during or shortly after discharge. Assisting caregivers with depressive symptoms to arrange for respite care and addressing negative physical and psychological changes may be priority areas for future interventions

Tracking Patterns of Needs During a Telephone Follow-up Program for Family Caregivers of Persons with Stroke

Purpose Programs that address stroke family caregiver needs and skill-building are recommended based on the literature and patient care guidelines for stroke rehabilitation. The purpose of this study was to explore patterns of perceived needs and skill-building during a stroke caregiver intervention program. Method Descriptive statistics were used to analyze data from 123 stroke caregivers enrolled in the intervention group of a randomized controlled clinical trial. Caregivers received 8 weekly telephone sessions, with a booster session a month later. At each session, the Caregiver Needs and Concerns Checklist (CNCC) was used to identify and prioritize current needs that were then addressed through skill-building strategies. Results Perceived needs changed over time. Information about stroke was the highest priority need during Session 1. Managing survivor emotions and behaviors was the highest priority for Sessions 2 through 4. Caregivers generally waited until Sessions 5 through 9 to address their own emotional and physical health needs. Physical and instrumental care needs were relatively low but stable across all 9 sessions. Skill-building was consistently high, though it peaked during Sessions 2 and 3. Conclusions Tracking patterns of needs and skill-building suggest appropriate timing for targeting different types of family caregiver support during stroke rehabilitation

Moral Distress and Associated Factors Among Baccalaureate Nursing Students: A Multisite Descriptive Study

Moral distress and its associated negative consequences among postlicensure nurses have been extensively discussed in the literature. Moral distress is defined as knowing the ethically correct action one should take but feeling constrained from acting on one’s convictions because of internal and external constraints (Epstein & Delgado, 2010; Hamric, 2014; Jameton, 1984; McCarthy & Gastmans, 2015; Musto, Rodney, & Vanderheide, 2015). The focus in much of the reviewed literature is on measuring and describing moral distress, moral residue (lingering feelings associated with moral distress), and subsequent deleterious consequences (frustration, apathy, compassio

Examining relationships between resilience protective factors and moral distress among student nurses

Aim: The purpose of this study was to identify relationships between resilience protective factors (RPFs) and moral distress among baccalaureate nursing students. Background: Students report moral distress associated with clinical practicum experiences. Enhancing resilience may minimize moral distress and associated consequences. Method: Correlation, pilot study. Two previously tested instruments were used to measure moral distress (Moral Distress Thermometer) and RPFs (Scale of Protective Factors). Results: Aggregate mean more distress rating was 3.67. Two of four RPF subcategories demonstrated a significant inverse correlation with moral distress rating. Inverse correlations were found between social support and moral distress (r = -.27, p \u3c .05), and between goal efficacy and moral distress (r = -.37, p \u3c .01). Total resilience scores also demonstrated a weak inverse correlation with moral distress (r = -.24, p \u3c .05). Conclusions: Findings help educators prioritize resilience enhancing educational strategies

Oncology Nurses’ Experiences with Prognosis Related Communication

poster abstractBackground: Oncology nurses have opportunities to engage in prognosis related communication with advanced cancer patients but often encounter barriers that impede patient prognosis understanding. Deficits in prognosis understanding have been associated with delays in transitions to end of life care, overly aggressive and potentially non-beneficial cancer treatments, and poor quality of life. Purpose: The purpose of this study was to describe nurses' experiences with prognosis related communication with advanced cancer patients. Methods: A framework of realism was used in this qualitative, descriptive design. A thematic analysis of audio-recorded interviews with oncology nurses (n=27) recruited from a Midwestern urban academic health center and 3 affiliated institutions was performed. Interviews were transcribed verbatim and accuracy checked. Data were coded by 3 experienced researchers. After coding, themes were identified, and a thematic map was developed. Methods to ensure trustworthiness of the findings were used. Results: Six themes were identified: Being in the middle, assessing the situation, barriers to prognosis communication, nurse actions, benefits of prognosis understanding, and negative outcomes. Nurses managed barriers through facilitation, collaboration, or independent actions to assist patients and/or families with prognosis understanding. Conclusions: Shortcomings in prognosis related communication with advanced cancer patients may contribute to negative outcomes for patients and nurses. Interventions to advance nurses’ abilities to facilitate and engage in prognosis communications are needed. Inter-professional communication skills education may also be beneficial

Preliminary Efficacy of a Stroke Caregiver Intervention Program for Reducing Depressive Symptoms

poster abstractBackground and Purpose: Stroke caregivers who lack skills because of unmet needs are at increased risk for depressive symptoms; which can impede rehabilitation of the survivor and increase the survivor’s risk for costly, long-term institutionalization. The Telephone Assessment and Skill-Building Kit (TASK) is an 8-week follow-up program based on individualized assessment of caregiver needs. The purpose of this study was to explore preliminary efficacy of the TASK program for improving stroke caregiver depressive symptoms. Methods: A subgroup of 15 caregivers who screened positive for mild to severe depressive symptoms at baseline (PHQ-9 > 5) were randomized to the TASK program (n=8) or an attention control group (n=7). Data were analyzed using Univariate ANCOVA, controlling for baseline scores and number of minutes spent with the nurse for each timepoint (4, 8, and 12 weeks after baseline). Partial ƞ2 was used to estimate effect sizes (.25 large). Results: Although not statistically significant because of the small sample size, medium to large improvements based on effect sizes were found in depressive symptoms for the TASK group relative to the control group at 4 weeks [F(1,11) = 4.15, p=.07, ƞ2=.27], 8 weeks [F(1,11) = 1.66, p=.22, ƞ2=.13], and 12 weeks after baseline [F(1,11) = 1.47, p=.25, ƞ2 =.12]. Adjusted PHQ-9 means for the TASK group at 4, 8, and 12 weeks ranged from 4.9 to 5.9; adjusted PHQ-9 means for the control group at 4, 8, and 12 weeks ranged from 9.0 to 10.8. Conclusions: Caregivers in the TASK group reduced their depressive symptoms to the mild range, while caregivers in the control group maintained their scores primarily in the moderately depressed range. Further testing of the TASK program in a larger randomized controlled clinical trial is warranted and is currently underway