Effects of chronic illness on daily life and barriers to self-care for older women: A mixed-methods exploration.

This mixed-methods study examined the subjective experience of living with chronic illness and identified barriers to self-care. Community-dwelling older women with chronic illness completed an initial (N = 138) and follow-up mailed survey 6 months later (N = 130). On average, participants reported four comorbid health conditions and the corresponding physical pain, activities curtailed or relinquished, and time and energy focused on managing health. Only 34% of participants practiced all 10 key self-care behaviors. Reported barriers to self-management included pain, lack of financial resources, and worry. In the regression analysis, having more depressive symptoms was a significant predictor of challenges with self-care behaviors.

Exploring family relationships through associations of comfort, relatedness states, and life closure in hospice patients: A pilot study.

OBJECTIVE: Research at the end of life tends to focus on the dying patient's symptoms, often overlooking issues associated with family interactions. However, many families struggle just to maintain or initiate these valuable connections. The purpose of our pilot study was to explore family relationships at the end of life and investigate associations among perceived comfort, relatedness states, and life closure. METHOD: This descriptive study used a cross-sectional design, and a convenience sample (n = 30; 18 women; mean age = 71 years) was recruited from patients admitted to a large not-for-profit hospice in northeastern Ohio. In-person interviews using the Hospice Comfort Questionnaire, Relatedness States Visual Analog Scales, and the Life-Closure Scale provided data for analyses. RESULTS: Family interactions that were not associated with the physical tasks of caregiving were related to life closure (r = 0.36, p = 0.001), and life closure and comfort were highly correlated (r = 0.69, p < 0.001). Participants residing in an inpatient setting had higher levels of involvement (t[18] = -2.07, p = 0.05) and comfort in relationships (t[28] = -2.06, p = 0.05) than those in the home setting. SIGNIFICANCE OF RESULTS: This is the first known study investigating the associations among comfort, relatedness, and life closure at the end of life. The majority of participants had high levels of involvement and comfort in their relationships, and they preferred interactions that required minimal effort. Studies that focus on both patients' and family members' perceptions of relationships are needed as well as outcome studies that test simple interventions.

Female stress urinary incontinence: an evidence-based, case study approach.

Over half of all women are affected by urinary incontinence at some point during their lives. Due to patients' embarrassment and health care providers' reluctance to discuss this sensitive subject, many women may go untreated, and in turn, suffer with disruptive symptoms and co-morbid complications associated with urinary incontinence. This article highlights a literature review of the evaluation and management of female stress urinary incontinence using a corresponding case study example. Increasing awareness and implementing evidence-based, nonsurgical treatment options are essential components of high-quality care for women with stress urinary incontinence. Urologic nurses and other health care professionals are in an ideal position to evaluate and identify strategies for the treatment of female stress urinary incontinence.

Longitudinal analysis of resourcefulness, family strain, and depressive symptoms in grandmother caregivers.

BACKGROUND: Grandmothers living with grandchildren face stressors that may increase depressive symptoms, but cognitive-behavioral strategies, such as resourcefulness, may reduce the effects of stressors on mental health. PURPOSE: This analysis examined the contemporaneous and longitudinal relationships among intra-family strain, resourcefulness, and depressive symptoms in 240 grandmothers, classified by caregiving status to grandchildren. METHODS: Grandmothers raising grandchildren, grandmothers living in multigenerational homes, and non-caregivers to grandchildren reported on intra-family strain, resourcefulness, and depressive symptoms using mailed questionnaires at three time points over 5 years. Structural equation modeling was used to evaluate the mediating effects of resourcefulness and the relationships between variables. DISCUSSION: Grandmother caregiver status had significant effects on depressive symptoms and intra-family strain but not on resourcefulness. At all waves, higher resourcefulness was associated with fewer depressive symptoms, which reduced appraisals of intra-family strain. CONCLUSIONS: Interventions focused on strengthening resourcefulness could reduce depressive symptoms over time.

Inventory of Patient-Reported Outcome Measures Used in the Non-Operative Care of Scoliosis: A Scoping Review.

It is unclear which patient-reported outcome measures (PROMs) can assess non-operative care for scoliosis. Most existing tools aim to assess the effects of surgery. This scoping review aimed to inventory the PROMs used to assess non-operative scoliosis treatment by population and languages. We searched Medline (OVID) as per COSMIN guidelines. Studies were included if patients were diagnosed with idiopathic scoliosis or adult degenerative scoliosis and used PROMs. Studies without quantitative data or reporting on fewer than 10 participants were excluded. Nine reviewers extracted the PROMs used, the population(s), language(s), and study setting(s). We screened 3724 titles and abstracts. Of these, the full texts of 900 articles were assessed. Data were extracted from 488 studies, in which 145 PROMs were identified across 22 languages and 5 populations (Adolescent Idiopathic Scoliosis, Adult Degenerative Scoliosis, Adult Idiopathic Scoliosis, Adult Spine Deformity, and an Unclear category). Overall, the most used PROMs were the Oswestry Disability Index (ODI, 37.3%), Scoliosis Research Society-22 (SRS-22, 34.8%), and the Short Form-36 (SF-36, 20.1%), but the frequency varied by population. It is now necessary to determine the PROMs that demonstrate the best measurement properties in the non-operative treatment of scoliosis to include in a core set of outcomes.

Don't get it twisted: Untangling the psychology of hair discrimination within Black communities.

Systems of oppression have shaped the prejudicial treatment of Black people based on the appearance of their hair, from the era of chattel enslavement to present-day America. Hair discrimination is a social injustice characterized by unfairly regulating and insulting people based on the appearance of their hair. A sampling of 90 African American community members narrated memories of hair discrimination using the guided hair autobiography method. While the hair narratives revealed texture, length, and style were the most common entry points into discriminatory behaviors, color, hair augmentation, density, and product choice were also tools of "othering" within a Eurocentric aesthetic value system. The narratives suggested that men and women experience interpersonal rejections early in their development in both emotionally intimate (at home with family) and public settings (at school with teachers and classmates). Sadness was the most frequently reported emotional response to these rejections. These findings extend the current literature on the psychological significance of hair within Black lives and pleads for policies of hair protection at work, hair-based professional development for teachers in schools, hair-influenced educational curriculum for students, community-based programming in hair care settings, and family interventions during hair combing interactions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Grandmother caregiving, family stress and strain, and depressive symptoms.

This study used the resiliency model of family stress, adjustment, and adaptation as the framework to examine the main and moderating effects of social support and resourcefulness in the relationship between family life stresses and strain and depressive symptoms in grandmothers raising grandchildren, grandmothers in multigenerational homes, and noncaregivers to grandchildren. A sample of 486 Ohio grandmothers, recruited using random and supplemental convenience methods, completed mailed surveys. Analysis of variance was used to examine differences in family life stresses and strain, resourcefulness, support, and depressive symptoms across the three groups of grandmothers. Hierarchical multiple regression analyses were used to examine whether family stresses and strains affected the grandmother's depressive symptoms and whether social support and resourcefulness moderated the relationship between family stresses and strain and grandmothers' mental health. Grandmothers raising grandchildren reported more depressive symptoms, but in multiple regression analyses of the full sample that controlled for demo-graphics, primary caregiving status was not related to depressive symptoms. More strain and less subjective support and resourcefulness were associated with higher depressive symptoms for all grandmothers, with 33% to 54% explained variances of such symptoms for each caregiving group and the full sample. Subjective support moderated the effects of strain and instrumental support moderated the effects of family life stresses on depressive symptoms. Social support and resourcefulness may help protect grandmothers from the effects of family stresses and strain, and interventions to enhance these factors may assist grandmother caregivers to achieve better mental health.

Coping Resources, Loneliness, and Depressive Symptoms of Older Women With Chronic Illness.

Chronic illness with its accompanying physical stressors poses a risk factor for loneliness and depression in later life. Testing a model of stress and coping, we examined the effects of three types of coping resources (religious coping; Selection, Optimization, and Compensation [SOC] adaptive strategies; and perceived social support) on the deleterious effects of chronic illness among older women. Community-dwelling older women (N = 138) with at least one chronic illness (M = 3.9, SD = 2.1) completed mailed questionnaires. Respondents reported multiple morbidities and 90% reported interference with daily life. Social support was associated with less loneliness and depression and mediated the relationship between physical health and loneliness. Our study demonstrates two distinct pathways to depressive symptoms: one through physical symptoms, pain, and disability, and another through the experience of loneliness. Findings support intervention approaches that address disability-related issues and loneliness, and assist older women with chronic illness in identifying and marshaling social support.

Use of a verbal electronic audio reminder with a patient hand hygiene bundle to increase independent patient hand hygiene practices of older adults in an acute care setting.

BACKGROUND: We hypothesized that the addition of a novel verbal electronic audio reminder to an educational patient hand hygiene bundle would increase performance of self-managed patient hand hygiene. METHODS: We conducted a 2-group comparative effectiveness study randomly assigning participants to patient hand hygiene bundle 1 (n = 41), which included a video, a handout, and a personalized verbal electronic audio reminder (EAR) that prompted hand cleansing at 3 meal times, or patient hand hygiene bundle 2 (n = 34), which included the identical video and handout, but not the EAR. The primary outcome was alcohol-based hand sanitizer use based on weighing bottles of hand sanitizer. RESULTS: Participants that received the EAR averaged significantly more use of hand sanitizer product over the 3 days of the study (mean ± SD, 29.97 ± 17.13 g) than participants with no EAR (mean ± SD, 10.88 ± 9.27 g; t73 = 5.822; P ≤ .001). CONCLUSIONS: The addition of a novel verbal EAR to a patient hand hygiene bundle resulted in a significant increase in patient hand hygiene performance. Our results suggest that simple audio technology can be used to improve patient self-management of hand hygiene. Future research is needed to determine if the technology can be used to promote other healthy behaviors, reduce infections, and improve patient-centered care without increasing the workload of health care workers.

Grandchildren's Depressive Symptoms and Perceptions of Family Functioning: Protective and Influencing Factors.

A recent increase in children living with grandparents places more children at increased risk for emotional, psychological, or behavioral problems. This study used the Resiliency Model of Family Stress, Adjustment, and Adaptation to examine how children's living situation, parental monitoring, child's resourcefulness, and perceived support affect depressive symptoms and perceived family functioning. Of participants, 36% ( n = 56) lived with their parents only, 44% ( n = 69) lived with a grandmother as their primary caregiver, and 20% ( n = 31) lived in a multigenerational household. Results indicate parental monitoring and support affected perceptions of family functioning. Subjective support and resourcefulness affected depressive symptoms. No effects were found from living situation and demographic factors. Resourcefulness had the strongest effect on depressive symptoms, with a 3-point decrease in symptoms for each incremental increase in resourcefulness. This study provides insight into factors influencing children's depressive symptoms and perceived family functioning, and provides direction for the development of future interventions.

Grandmothers' transitions in caregiving to grandchildren.

Many grandmothers experience transitions in their caregiving roles to grandchildren as living arrangements change and parents assume more or less responsibility. The meanings of these transitions have received little attention, yet life transitions can be stressful. This qualitative study focuses on learning how grandmothers perceive these changes in household composition and the meanings these changes have. Analysis of semistructured telephone interviews with 26 transitioning grandmothers identified themes, including mixed feelings, changes in personal freedom, flexibility with unpredictable changes, spirituality as strength, commitment to grandchildren, and role transformation. The majority of status changes were from multigenerational or primary caregiving homes to non-co-resident status. The meaning of the changes differed by status groups. The frequency of caregiving changes and the unique meanings of such changes extend our understanding of grandmothers as caregivers. Increased awareness and understanding of these meanings are important for nurses as they provide health care for this increasing population.

Grandmothers, caregiving, and family functioning.

OBJECTIVES: We used McCubbin's Resiliency Model of Family Stress, Adjustment and Adaptation ( McCubbin, Thompson, & McCubbin, 2001) to examine how demographic factors, family stress, grandmother resourcefulness, support, and role reward affect perceptions of family functioning for grandmothers raising grandchildren, grandmothers living in multigenerational households, and grandmothers not caregiving for grandchildren. METHODS: A sample of 486 grandmothers completed a mailed questionnaire. We used structural equation modeling to (a) test the effects of demographic factors (i.e., grandmother's age, race, marital status, and employment), family stressful life events and strain, grandmother's resourcefulness, subjective and instrumental support, and role reward on perceptions of family functioning for each grandmother group; (b) evaluate differences in the measurement and structural models between the grandmother groups using multisample analysis; and (c) test the model on the full sample, coding for caregiver status. RESULTS: The models did not differ significantly by grandmother group; therefore we assessed the composite model using a multisample analysis. We found general support for the resiliency model and equivalence of the models across grandmother groups. Less support, resourcefulness, and reward, and more intrafamily strain and stressful family life events contributed to perceptions of worse family functioning. DISCUSSION: Findings demonstrate the importance of the quality of family functioning for grandmothers in all types of families.

Evaluating an Online Resourcefulness Training Intervention Pilot Test Using Six Critical Parameters.

Few resources are available to help grandmother caregivers to grandchildren manage their complex family situations that may have immediate and long-term consequences for themselves and their families. Resourcefulness training is an intervention designed to help grandmothers improve their ability to deal with these problems. The purpose of this pilot study was to evaluate the necessity, feasibility, acceptability, fidelity, safety, and effectiveness (i.e., effect sizes) of an online, computer-based resourcefulness training intervention that was adapted from a face-to-face intervention. Twelve grandmothers raising or living with grandchildren participated in the pilot intervention that included (a) watching an instructional video on resourcefulness, (b) completing two online questionnaires over a 6-week time period, and (c) writing in an online journal every day for 4 weeks. Data are evaluated within the context of the six parameters important to intervention development. Qualitative and quantitative results provide initial support for all six parameters. Recommendations to improve aspects of the intervention are discussed.

A comparison of imputation techniques for handling missing data.

Researchers are commonly faced with the problem of missing data. This article presents theoretical and empirical information for the selection and application of approaches for handling missing data on a single variable. An actual data set of 492 cases with no missing values was used to create a simulated yet realistic data set with missing at random (MAR) data. The authors compare and contrast five approaches (listwise deletion, mean substitution, simple regression, regression with an error term, and the expectation maximization [EM] algorithm) for dealing with missing data, and compare the effects of each method on descriptive statistics and correlation coefficients for the imputed data (n = 96) and the entire sample (n = 492) when imputed data are inculded. All methods had limitations, although our findings suggest that mean substitution was the least effective and that regression with an error term and the EM algorithm produced estimates closest to those of the original variables.

Grandmothers and caregiving to grandchildren: continuity, change, and outcomes over 24 months.

PURPOSE: Transitions in caregiving, such as becoming a primary caregiver to grandchildren or having adult children and grandchildren move in or out, may affect the well-being of the grandmother. DESIGN AND METHODS: This report describes caregiving patterns at 3 time points over 24 months in a sample of 485 Ohio grandmothers and examines the effects of stability and change in grandmother caregiving roles (raising a grandchild, living in a multigenerational home, or not caregiving to grandchildren). Drawing on the Resiliency Model of Family Stress, the study examined caregiving stress and reward, intrafamily strain, social support, resourcefulness, depressive symptoms, mental and physical health, and perceived family functioning. Caregiver group, time of measurement, switching between caregiver groups, and baseline age, race, education, work status, and marital status were considered as independent variables within the context of a one-way treatment structure in a mixed-model multivariate analysis. RESULTS: There were significant caregiver group effects for all variables, except mental health and resourcefulness. Grandmothers raising grandchildren reported the most stress, intrafamily strain, and perceived problems in family functioning, the worst physical health and more depressive symptoms, and the least reward and subjective support. Across groups, there were significant time effects, with worsening physical health and increased stress over time. Switching to higher levels of caregiving was associated with worsening physical health and increases in stress, intrafamily strain, and perceived problems in family functioning. IMPLICATIONS: Recommendations for research and for practice, especially during times of caregiving transition or for grandmothers raising grandchildren, are discussed.