Caregiving for patients with heart failure: impact on patients' families.

BACKGROUND: Factors that affect the impact of caregiving on patients' family members who provide care to patients with heart failure have not been adequately addressed. In addition, social support and positive aspects of caregiving have received little attention. OBJECTIVE: To identify factors associated with the impact of caregiving. METHODS: Self-report data were collected from 76 dyads of patients with heart failure and their family caregivers. Clinical data were obtained from medical records. RESULTS: A sense of less family support for caregiving was associated with a higher New York Heart Association class of heart failure, being a nonspousal caregiver, lower caregivers' perceived control, and less social support. More disruption of caregivers' schedules was associated with higher class of heart failure, more care tasks, and less social support. Greater impact of caregiving on caregivers' health was related to more recent patient hospitalization, lower caregivers' perceived control, and less social support. Nonwhite caregivers and caregivers whose family member had fewer emergency department visits felt more positive about caregiving than did other caregivers. Social support had a moderating effect on the relationship between patients' comorbid conditions and positive aspects of caregiving. CONCLUSIONS: Caregiving has both positive and negative effects on family caregivers of patients with heart failure. The findings suggest the need for interventions to increase caregivers' sense of control and social support. Family caregivers may need additional support immediately after patient hospitalizations to minimize the negative impact of caregiving.

Meeting the nursing faculty shortage challenge: an accelerated doctoral program in nursing.

In 2003, the Gordon and Betty Moore Foundation partnered with a major west coast school of nursing to create an accelerated doctoral program in nursing. The program's chief aim was to address the nursing shortage by increasing the number of nurse faculty by funding 42 doctoral students in five cohorts. Students accepted into the accelerated program receive a generous stipend and commit to earn their doctorate in 3 years and teach for 3 years after graduation at 1 of 17 area nursing programs. Two cohorts have graduated from the accelerated program and are currently in faculty positions. This article describes the accelerated doctoral program and the academic progression and postgraduation employment of the first two cohorts.

A review of cardiovascular risk factors in US military personnel.

As the civilian population exhibits increasing trends in major cardiovascular (CV) risk factors in younger age groups, the US military is observing similar trends. These worrisome developments are seen even in young adulthood. Despite the need for a fit, combat-ready force, increases in CV risk are increasingly evident in the military population. This review provides an overview of coronary artery disease in the young and the prevalence of risk factors in the military population. With increases in current military operations in an acutely stressful environment, the role of stress and the manifestation of CV disease are also examined.

Compliance with antihypertensive medication in Chinese immigrants: cultural specific issues and theoretical application.

This paper presents a theoretical framework to study medication compliance in Chinese immigrants with hypertension (HTN). The framework was developed from (a) literature review of medication compliance and Chinese cultural belief/practices and (b) critique of major models of health behaviors in persons with chronic illness. Four constructs shape the model: motivation, cultural health perceptions, modifying factors, and cultural health care activities. Among these constructs, cultural health perceptions and health care activities are especially important because these address how Chinese immigrants perceive HTN and antihypertensive treatments and how they manage HTN. Using a culturally sensitive model is important to guide studies of medication compliance in this population and to assist health care providers to support compliance with antihypertensive treatments for Chinese immigrants.

Cultural factors and medication compliance in Chinese immigrants who are taking antihypertensive medications: instrument development.

Chinese immigrants in the United States have a moderate to high prevalence of hypertension, but little is known about antihypertensive medication compliance in Chinese immigrants. This study presents some first-generation measures of antihypertensive medication compliance in a sample of Chinese immigrants. A literature review and two qualitative pilot studies were conducted to generate culturally sensitive instruments. Items were developed to assess cultural factors and medication compliance in Chinese immigrants receiving antihypertensive medications. Cultural factors included measures of cultural health perception of hypertension, health perceptions of Chinese herbs, health perceptions of Western medications, beneficial self-care behaviors, and social support. Four medication compliance scales were developed. The applicability of these scales was tested in a Chinese immigrant population (n=200). Cronbach's alpha for the cultural factors scales ranged from .57 to .91. Two of the medication compliance scales had Cronbach's alphas above .60. Results showed that most of the scales are applicable and acceptable in a Chinese immigrant population and had good reliability. However, further testing with a larger sample in other regions of the country is indicated.