A seven country comparison of nurses' perceptions of their professional practice environment.

Papastavrou E., Efstathiou G., Acaroglu R., da Luz M.D.A., Berg A., Idvall E., Kalafati M., Kanan N., Katajisto J., Leino-Kilpi H., Lemonidou C., Sendir M., Sousa V.D. & Suhonen R. (2011) Journal of Nursing Management A seven country comparison of nurses' perceptions of their professional practice environment Aims To describe and compare nurses' perceptions of their professional practice environment in seven countries. Background There is evidence of variation in the nursing professional practice environments internationally. These different work environments affect nurses' ability to perform and are linked to differing nurse and patient outcomes. Methods A descriptive, comparative survey was used to collect data from orthopaedic and trauma nurses (n = 1156) in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and Kansas, USA using the 39-item Revised Professional Practice Environment instrument. Results Differences were found between participants from the northern countries of Europe, Kansas, USA, and the Mediterranean countries regarding perceptions about control over practice. No between-country differences were reported in the internal work motivation among the nurses from any of the participating countries. Conclusions Although between-country differences in nurses' professional practice environment were found, difficulties related to demographic, cultural and health system differences and the way in which nursing is defined in each country need to be considered in the interpretation of the results. Implications for Nursing Management The results support investment to improve nurse's work environment, which is important for improving the quality of patient care, optimizing patient outcomes and developing the nursing workforce.

Nurses' perceptions of individualized care: an international comparison.

AIM: This paper is a report of a study of internationally-based differences in nurses' perceptions of individualized care in orthopaedic surgical in-patient wards. BACKGROUND: Individualized care is valued in healthcare policy, practice and ethical statements as an indicator of care quality. However, nurses' assessments of individualized care are limited and comparative cross-cultural studies on individualized nursing care are lacking. METHODS: A descriptive comparative survey was used to sample orthopaedic surgical nurses (n = 1163) working in 91 inpatient wards in 34 acute hospitals in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and the United States of America. Data were collected between March and November 2009 using the Individualized Care Scale-Nurse and analysed using descriptive and inferential statistics. RESULTS: Nurses in different countries perceived that they supported patients' individuality generally and provided individualized care during nursing activities. Although the highest scores were in support of patients' individuality in the clinical situation both through nursing provision and nurses' perceptions of individuality, there were between-country differences within these scores. Generally, the Greek and American nurses gave the highest scores and the Turkish, Cypriot and Portuguese nurses the lowest. CONCLUSIONS: Between-country differences found may be attributed to differing roles of nurses, care processes, healthcare systems and/or the ways nursing care is defined and organized. As this was the first time the Individualized Care Scale-Nurse was used in an international context, the results are formative and indicate the need to continue studies in this area.

Cross-cultural validation and psychometric evaluation of the Spanish Brief Religious Coping Scale (S-BRCS).

PURPOSE: To evaluate the psychometric properties of the Spanish Brief Religious Coping Scale (S-BRCS). DESIGN: A descriptive correlational design was used to conduct the study among a convenience sample of 121 Mexican Americans with diabetes. RESULTS: The positive and negative religious coping subscales had Cronbach's alphas of .85 and .86, respectively. All interitem and item-to-total correlations for each subscale were above the recommended criteria of .30. Factor loadings of the positive subscale using oblique (oblimin) and orthogonal (varimax) rotation ranged from .71 to .86 and from .72 to .86, respectively.Factor loadings of the negative subscale using oblimin and varimax rotation ranged from .64 to .83 and from .63 to .83,respectively. DISCUSSION AND CONCLUSIONS: The S-BRCS was found to be a valid and reliable instrument to measure religious coping among Spanish-speaking Mexican Americans with type 2 diabetes. IMPLICATIONS FOR FURTHER RESEARCH AND PRACTICE: Further psychometric evaluation of the S-BRCS among larger sample of Mexican Americans and other Hispanic ethnic groups is warranted. The S-BRCS has the potential to become a standard instrument that can be used by clinicians who work with Hispanic clients with diabetes mellitus to provide culturally competent diabetes care.

Depression, coronary artery disease, type 2 diabetes, metabolic syndrome and quality of life in Taiwanese adults from a cardiovascular department of a major hospital in Southern Taiwan.

AIMS: To examine the relationships between depression, coronary artery disease, type 2 diabetes, metabolic syndrome and quality of life in Taiwanese adults from a cardiovascular department of a major hospital in Taiwan. BACKGROUND: Research suggests associations between depression, metabolic syndrome and quality of life. Despite this fact, few studies have investigated these relationships among Taiwanese. DESIGN: A cross-sectional descriptive correlational design was used to conduct this study. METHODS: A convenience sample of 140 adults participated in the study. Data were analysed with descriptive statistics, Pearson's correlations, hierarchical regression and t-tests. RESULTS: Almost a half of the subjects (46.5%) had metabolic syndrome. The most common combination of metabolic syndrome criteria was elevated blood glucose, central obesity and high blood pressure (23.7%). A greater number of individuals had coronary artery disease (72.9%), type 2 diabetes (35%) and/or depression (21.4%). Type 2 diabetes and depression were significant predictors of overall quality of life (ß = -0.16, p < 0.01 and ß = -0.63, p < 0.001, respectively). In addition, there were significant differences between individuals with and without type 2 diabetes and/or depression regarding overall quality of life scores; t (138) = 3.50, p < 0.01); and t (138) = 7.80, p < 0.001), respectively. CONCLUSIONS: Coronary artery disease, type 2 diabetes and depression were common among our sample of individuals with metabolic syndrome. Those with diabetes and/or depression had worse quality of life than those without those diseases. RELEVANCE TO CLINICAL PRACTICE: Nurses need to be prepared to assess and intervene in preventing or treating depression among patients with chronic diseases, especially those with coronary artery disease, type 2 diabetes and metabolic syndrome. When individuals are treated for depression, they are more likely to engage in self-management of their diseases, which will prevent complications and improve their quality of life.

Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline.

RATIONALE, AIMS AND OBJECTIVES: The diversity of the population worldwide suggests a great need for cross-culturally validated research instruments or scales. Researchers and clinicians must have access to reliable and valid measures of concepts of interest in their own cultures and languages to conduct cross-cultural research and/or provide quality patient care. Although there are well-established methodological approaches for translating, adapting and validating instruments or scales for use in cross-cultural health care research, a great variation in the use of these approaches continues to prevail in the health care literature. Therefore, the objectives of this scholarly paper were to review published recommendations of cross-cultural validation of instruments and scales, and to propose and present a clear and user-friendly guideline for the translation, adaptation and validation of instruments or scales for cross-cultural health care research. METHODS: A review of highly recommended methodological approaches to translation, adaptation and cross-cultural validation of research instruments or scales was performed. Recommendations were summarized and incorporated into a seven-step guideline. Each one of the steps was described and key points were highlighted. Example of a project using the proposed steps of the guideline was fully described. CONCLUSIONS: Translation, adaptation and validation of instruments or scales for cross-cultural research is very time-consuming and requires careful planning and the adoption of rigorous methodological approaches to derive a reliable and valid measure of the concept of interest in the target population.

Cross-cultural validation and psychometric properties of the Greek version of the Caring Behaviors Inventory: a methodological study.

RATIONALE: Translation, adaptation and cross-cultural validation of instruments or scale to measure concepts of interest among different populations can facilitate sharing of knowledge and advance cross-cultural research globally, especially in countries with diverse populations. AIMS AND OBJECTIVES: This is a two-phase study aiming to: (1) translate, adapt and cross-validate the 24-item English version of Caring Behaviors Inventory into Greek; and (2) evaluate the psychometric properties of the Greek version (CBI-GR). METHODS: A descriptive correlational design was used to conduct the study. The procedure involved professional translators, committee approach, and a sample of nurses and patients. The psychometric evaluation of the CBI-GR used a sample of 245 Greek and Cypriot medical-surgical nurses. Data analyses comprised internal consistency reliability (Cronbach's alpha coefficient), stability (test-retest) reliability, item analysis and confirmatory factor analysis. RESULTS: The Cronbach's alpha for the overall CBI-GR was 0.92 and ranged from 0.76 to 0.87 for the subscales. Correlation coefficients between test and retest for the overall CBI-GR was r = 0.83 and ranged from r = 0.69 to 0.78 for its subscales. Confirmatory factor analysis of the scale supports its four-factor structure and the model indexes were adequate: X(2) (239) = 515.54, P < 0.001; comparative fit index = 0.91; incremental fit index = 0.91; and Tucker Lewis index = 0.90; parsimony normed fit index = 0.73; parsimony comparative fit index = 0.79; and root mean square of approximation = 0.07. CONCLUSIONS: The CBI-GR is comparable with the original 24-item English version of the CBI and it is suitable to measure nurse caring among Greek-speaking nurses. Further psychometric testing of the instrument among nurses and patients is warranted.

Major depressive disorder and insulin resistance in nondiabetic young adults in the United States: the National Health and Nutrition Examination Survey, 1999-2002.

OBJECTIVE: The association between depression and insulin resistance has been evaluated in previous studies with conflicting results. This study aimed to explore the relationship between major depressive disorder (MDD) and insulin resistance among nondiabetic young adult men and women in the United States. METHOD: Analyses of cross-sectional data from the National Health and Nutrition Examination Survey (NHANES), 1999-2002, were conducted. The nationally representative sample consisted of 279 men and 358 women aged 20-39 years. MDD was determined by the WHO Composite International Diagnostic Interview (CIDI). Insulin resistance was measured by the homeostasis model assessment for insulin resistance. RESULTS: Of 637 subjects, 16 men and 18 women had MDD (weighted percentage = 6.6%, SE = 1.2). Using logistic regression, no significant association was found between MDD and insulin resistance among the nondiabetic young adults in bivariate analysis (ß = -0.01, OR = 0.99, 95% CI = [0.38, 2.57], p = .98). A significant interaction effect between gender and MDD was observed. For men, MDD was negatively associated with insulin resistance after adjusting for age, race/ethnicity, waist circumference, smoking status, systolic blood pressure and triglyceride level (ß = -2.12, OR = 0.12, 95% CI = [0.02, 0.62], p = .01). No significant association between MDD and insulin resistance among women was found (ß = 0.61, OR = 1.84, 95% CI = [0.47, 7.14], p = .38). CONCLUSIONS: Overall findings suggest there is no significant association between MDD and insulin resistance among nondiabetic young adults aged 20-39 years. However, gender differences in this relationship were noted.

Confirmatory factor analysis of the depressive cognition scale.

The purpose of this study was to validate the single-factor structure of the Depressive Cognition Scale (DCS) among individuals from the U.S. general population. The sample was composed of 629 adults from 42 states of the United States. All measures of model fit of the DCS exceeded the recommended criteria for the good model fit (χ(2)/df = 2.57, goodness-of-fitness index = .98, adjusted goodness-of-fitness index = .96, comparative fit index = .99, Tucker Lewis index = .98, root mean square error of approximation = .05, root mean residual = .01, and the P value for test of close fit = .464). Thus, the DCS was found to be a reliable and valid instrument to measure depressive cognitions among individuals from the general population.

Perceptions of breastfeeding and planned return to work or school among low-income pregnant women in the USA.

AIMS AND OBJECTIVES: To describe the perceptions of breastfeeding in low-income pregnant women to understand their needs better as they plan to return to work or school. BACKGROUND: Maternal employment has a negative impact on breastfeeding duration. Yet there is insufficient research on challenges and facilitators regarding breastfeeding and employment issue among low-income women in the USA. Knowing the perceptions of breastfeeding among low-income pregnant women and their plan to return to work or school may have implications for nurses and midwives in providing quality care. DESIGN: Qualitative study using focus group interviews. METHODS: The research setting consisted of three Women, Infants and Children clinics (WIC) in a midwestern city of the USA. Seventeen pregnant women (aged 19-35) participated in focus group interviews. Data were coded and analysed for themes and patterns using the QSR software - NVivo 6. RESULTS: Eleven participants were single. Ten women were primigravida, and seven were multipara. The following five themes were identified: (1) perceived benefits of breastfeeding; (2) general perceptions of breastfeeding; (3) maternal concerns; (4) having the right support; and (5) anticipated challenges of combining breastfeeding and work. Conclusions. Low-income women anticipated substantial barriers for breastfeeding when they planned to combine breastfeeding and work or school. The results of this study have many implications for public health practice, research and policy. Educating employers and the public at large about the health and economic benefits derived from long-term breastfeeding could help promote breastfeeding awareness. RELEVANCE TO CLINICAL PRACTICE: Strategies supporting breastfeeding among low-income working women must be provided at multiple levels to help overcome the barriers they concern. Health care providers should help women gain confidence by minimising their uncertainties and fears about breastfeeding to prepare them to continue breastfeeding successfully after returning to work.

Development of the Huntington disease family concerns and strategies survey from focus group data.

Health concerns and management strategies among families of young and middle-age adults with Huntington's disease (HD) are unknown. This study developed and tested psychometric properties of the Huntington Disease Family Concerns and Strategies Survey (HDFCSS). Focus group data from 91 adult family members were used to develop content. Content analysis yielded four domains that were transferred into Personal, Person With HD, Community Health Care Services, and Strategies scales. Focus group data, expert validation, and cognitive interviews demonstrated survey content validity. Cronbach's alpha internal consistency coefficients for the scales were 0.83 or above. The measure can be used to generate reliable and valid data to identify adult family members' health-related concerns and management strategies for themselves and persons with HD.

Factorial structure of the perception of risk factors for type 2 diabetes scale: exploratory and confirmatory factor analyses.

RATIONALE, AIMS AND OBJECTIVES: The extent to which individuals' perceptions of risk for type 2 diabetes are related to their actual risks and health-promoting behaviours is not well known. Yet perception of risk for type 2 diabetes may influence the likelihood that individual would engage in preventive behaviours. The purpose of this study was to evaluate the psychometric properties of the perception of risk factors for type 2 diabetes (PRF-T2DM). METHODS: A descriptive, correlational, methodological design was used to conduct this study. The sample consisted of 629 adults from 42 states of the United States. A demographic questionnaire, the PRF-T2DM, the health-promoting lifestyle profile II and the depressive cognition scale were used to collect the data. Data analyses consisted of descriptive statistics, scale and item analyses, Pearson's correlation analysis, and exploratory and confirmatory factor analyses. RESULTS: The PRF-T2DM has a Cronbach's alpha of 0.81. Both extracted factors had Cronbach's alphas of 0.74 and 0.80, respectively. Most inter-item and item-to-total correlation coefficients for factor 1 and factor 2 met the recommended criteria of r=0.30 to r=0.70. The PRF-T2DM achieved all minimum recommended criteria for model fit (χ(2) /d.f.=2.33, goodness of fit index=0.95, adjusted goodness of fit index=0.93, comparative fit index=0.94, root mean square error of approximation=0.05, root mean residual=0.05 and the P value for test of close fit=0.33). CONCLUSIONS: All statistical estimates and measures of model fit were above the standard recommended criteria. The scale has potential uses in research and clinical practice. Further development and psychometric evaluation of the PRF-T2DM is warranted.

Psychometric evaluation of the Employer Support for Breastfeeding Questionnaire (ESBQ).

The purpose of this descriptive methodological study was to develop and evaluate the psychometric properties of the Employer's Support for Breastfeeding Questionnaire (ESBQ). The convenience sample consisted of 380 business owners, managers, or supervisors from the Midwestern United States. Data were collected using Web and paper-based questionnaires from January to March 2008. Psychometric evaluation included item analysis, scale reliability, and construct validity. The ESBQ subscales had Cronbach's alphas ranging from 0.85 to 0.92. Most inter-item and item-to-total correlations were above the recommendation of 0.30. The test-retest reliability of each subscale ranged from 0.93 to 1.0. Confirmatory factor analysis supported the construct validity of the scale. The comparative fit index (CFI) and the non-normal fit index (NNFI) were 0.90 and 0.91, respectively, and the root mean square error of approximation (RMSEA) was 0.05. Findings supported the ESBQ as reliable, valid, and theoretically consistent with the theory of planned behavior.

Predictors of self-reported memory problems in patients with ovarian cancer who have received chemotherapy.

PURPOSE/OBJECTIVES: To examine the association between self-report of memory problems and the most commonly reported concurrent symptoms by women with ovarian cancer who have received chemotherapy. DESIGN: Secondary analysis. SETTING: Midwestern university-based school of nursing. SAMPLE: 638 women with ovarian cancer participating in a larger study who had received chemotherapy and 68 women with ovarian cancer who had not received chemotherapy. METHODS: Responses to a demographic questionnaire, disease and treatment history survey, and symptom severity index were analyzed using Pearson's correlations, hierarchical regression analysis, and Welch t tests for unequal sample size. MAIN RESEARCH VARIABLES: Self-rating of memory problems, time since chemotherapy, education level, and self-rating of commonly reported symptoms associated with ovarian cancer. FINDINGS: Nine symptoms accounted for 37% of the variance of memory problems (controlling for time since chemotherapy and education level). Significant predictors of memory problems included fatigue, mood swings, numbness or tingling, and sleep disturbance. Mean scores for self-reported memory problems were significantly different for participants who received chemotherapy compared to those who had not. CONCLUSIONS: Findings suggest that memory problems were common following chemotherapy for ovarian cancer. Additional prospective study is warranted to evaluate potential mechanisms underlying these symptom interactions. Further qualitative study may be of value to describe the patient experience and identify effective coping strategies. IMPLICATIONS FOR NURSING: Patient and family education should include information about the potential for memory problems following chemotherapy for ovarian cancer.

Reliability, validity and factor structure of the Appraisal of Self-Care Agency Scale-Revised (ASAS-R).

RATIONALE, AIMS AND OBJECTIVES: Self-care agency is a fundamental concept in nursing and health care research. Having self-care agency enhances an individual's health-promoting behaviours and/or specific capabilities for chronic disease self-management. The purpose of this study was to continue the development and psychometric testing of the Appraisal of Self-Care Agency - Revised (ASAS-R). METHODS: A cross-sectional methodological design was used to examine the reliability, validity and factor structure of the ASAS-R among individuals from the general population. The sample consisted of 629 adults who were randomly selected to conduct an exploratory factor analysis (EFA; n=240) and a confirmatory factor analysis (CFA; n=389) of the scale. A demographic questionnaire, the ASAS-R and the Health-Promoting Lifestyle Profile (HPLP-II) were the measures used to collect the data. RESULTS: The final 15-item three-factor ASAS-R had an overall Cronbach's alpha (α) of 0.89. The three factors extracted, rotated and scored in this study were labelled: having power for self-care, developing power for self-care and lacking power for self-care. All inter-items and item-to-total correlations met recommended criteria of r=0.30 to r=0.70, except for one of the items that had an item-to-total correlation of 0.71, slightly exceeding the maximum recommended item-to-total correlation. The three factors had Cronbach's alphas of 0.86, 0.83 and 0.79, respectively. The three factors together explained 61.7% of the scale items variance. Each item of the scale had a strong factor loading ranging from 0.52 to 0.81. All measures of model fit exceeded the recommended criteria, indicating that the 15-item ASAS-R had a very good fit (χ(2) /d.f.=1.97, GFI=0.94, AGFI=0.92, CFI=0.96, TLI=0.95, RMSEA=0.05, RMR=0.05 and the PCLOSE=0.48). CONCLUSIONS: The 15-item three-factor ASAS-R is a short, reliable and valid instrument to measure self-care agency among individuals from the general population, but further psychometric evaluation is needed among individuals with chronic diseases, especially those with diabetes mellitus.

A new scale to measure family members' perception of community health care services for persons with Huntington disease.

UNLABELLED: RATIONALE, AIMS, AND OBJECTIVES: Huntington disease (HD) is a progressive genetic brain disease leading to disruptive cognitive, behavioural and physical impairments. Persons with the condition and their caregivers need appropriate and accessible health care services to help them manage the disease adequately. The purpose of this study was to evaluate the psychometric properties of a new scale that measures family members' perception of community health care services (CHCS) for persons with HD. METHODS: A methodological design was used to examine the initial reliability and dimensionality of the CHCS scale among 245 family members of persons with a diagnosis of HD. Data analysis consisted of computing Cronbach's alpha coefficients, calculating the 95% confidence interval for alpha and performing item-analysis and exploratory factor analysis. RESULTS: Reliability of the scale based on Cronbach's alpha was 0.83. Factor analysis using principal component analysis and varimax rotation suggested that three interpretable factors underlie the scale. Factor 1, HD knowledge, had alpha = 0.82, eigenvalue of 4.67 and explained 33.42% of the variance; factor 2, HD community resources, had alpha = 0.62, eigenvalue of 1.68 and explained 12.02% of the variance; factor 3, individualized HD management, had alpha = 0.77, eigenvalue of 1.45 and explained 10.39% of the variance. CONCLUSIONS: Findings from this study provide evidence of both construct validity and internal consistency reliability of the CHCS scale. Further psychometric testing of the scale in other samples of family caregivers of persons with HD is warranted.

The use of smart pumps for preventing medication errors.

The use of smart pumps can be helpful for preventing medication errors, especially with high-alert drugs in vulnerable critical care patient populations. A literature review was conducted to determine the evidence supporting the use of smart pumps for preventing medication errors. Cinahl and Medline databases from January 2003 through July 2008 were searched for English-language publications on the use of smart pumps and medication errors. Review of these publications revealed that well-designed research is still lacking with respect to the effectiveness of smart pumps in preventing medication errors. Nevertheless, findings indicate new directions for clinical practice and future research.

Knowledge and attitude: important components in diabetes education.

This descriptive cross-sectional study was conducted from March to November 2007 at a research and community services center of a Brazilian university. It aimed to explore the knowledge and attitude of people with diabetes mellitus who were attending a diabetes self-care education program. The sample was composed of 82 adults with diabetes mellitus. Data were collected through the Portuguese versions of the Diabetes Knowledge Questionnaire (DKN-A) and the Diabetes Attitude Questionnaire (ATT-19). Results revealed that 78.05% of the participants obtained scores higher than eight on knowledge about diabetes, which indicates they have knowledge and understand the disease. Scores on attitude ranged from 25 to 71 suggesting difficulty in coping with the disease. We conclude that although participants obtained a good score on knowledge, their attitude did not change so as to more adequately cope with the disease.

Knowledge and attitude: important components in diabetes education / Conocimiento y actitudes: componentes para la educación en diabetes / Conhecimento e atitudes: componentes para a educação em diabetes

This descriptive cross-sectional study was conducted from March to November 2007 at a research and community services center of a Brazilian university. It aimed to explore the knowledge and attitude of people with diabetes mellitus who were attending a diabetes self-care education program. The sample was composed of 82 adults with diabetes mellitus. Data were collected through the Portuguese versions of the Diabetes Knowledge Questionnaire (DKN-A) and the Diabetes Attitude Questionnaire (ATT-19). Results revealed that 78.05 percent of the participants obtained scores higher than eight on knowledge about diabetes, which indicates they have knowledge and understand the disease. Scores on attitude ranged from 25 to 71 suggesting difficulty in coping with the disease. We conclude that although participants obtained a good score on knowledge, their attitude did not change so as to more adequately cope with the disease.

Estudio transversal, realizado en un centro de investigación y extensión universitaria brasileño, en el período de marzo a noviembre de 2007. El objetivo fue verificar conocimientos y actitudes de personas con diabetes mellitus que participaban de un programa de educación en el auto cuidado en diabetes. Como método se usó una muestra constituida por 82 adultos con diabetes mellitus. Para recolección de los datos fueron utilizadas versiones portuguesas de los cuestionarios Diabetes Knowledge Questionnaire (DKN-A) y Diabetes Attitude Questionnaire (ATT-19). Los resultados mostraron que 78,05 por ciento tuvieron puntajes superiores a 8 en relación al conocimiento en diabetes, indicando conocimiento y comprensión acerca de la enfermedad. En cuanto a la actitud, los puntajes variaron entre 25 y 71 puntos, sugiriendo dificultad en el enfrentamiento de la enfermedad. Se concluye que, a pesar que los participantes obtuvieron un buen puntaje en el conocimiento, todavía así no modificaron la actitud para el enfrentamiento más adecuado de la enfermedad.

Estudo transversal, realizado em um centro de pesquisa e extensão universitária brasileiro, no período de março a novembro de 2007. O objetivo foi verificar conhecimentos e atitudes de pessoas com diabetes mellitus que participavam de um programa de educação para o autocuidado em diabetes. Como método usou-se amostra constituída por 82 adultos com diabetes mellitus. Para coleta de dados foram utilizadas versões portuguesas dos questionários Diabetes Knowledge Questionnaire (DKN-A) e Diabetes Attitude Questionnaire (ATT-19). Os resultados mostraram que 78,05 por cento tiveram escores superiores a 8 em relação ao conhecimento em diabetes, indicando conhecimento e compreensão acerca da doença. Quanto à atitude, os escores variaram entre 25 e 71 pontos, sugerindo dificuldade no enfrentamento da doença. Conclui-se que, apesar de os participantes terem obtido bom escore para o conhecimento, ainda assim não modificaram a atitude para o enfrentamento mais adequado da doença.

New measures of diabetes self-care agency, diabetes self-efficacy, and diabetes self-management for insulin-treated individuals with type 2 diabetes.

AIMS AND OBJECTIVES: To develop and refine three new scales that measure diabetes self-care agency, diabetes self-efficacy and diabetes self-management to reflect the American Diabetes Association current standards of diabetes care and the American Association of Diabetes Educators self-care behaviours. And, to establish the clarity, consistency and content validity of the scales. BACKGROUND: There is a need to have valid and reliable instruments or scales to assess an individual's diabetes self-care agency, self-efficacy and self-management to plan appropriate interventions that can be effective in improving glycaemic control and delaying or preventing diabetes-related complications. DESIGN: A methodological design was used to conduct this study. METHODS: Ten clinicians and 10 insulin-treated individuals with type 2 diabetes (T2DM) from a diabetes care center in the southern USA participated in this study. Analysis consisted of inter-rater agreement to determine clarity and consistency with standards of diabetes care and content validity of individual items on the scales (I-CVI) and the overall scales (S-CVI/Ave) to determine relevance for current diabetes care practice. RESULTS: All I-CVI and S-CVI/Ave of the DSES exceeded the minimum acceptable criteria. All I-CVI and the S-CVI of the DSMS also exceeded the minimum accepted criteria, except for one item that had I-CVI = 0.70. Evaluation of the items and the directions of the scales by the sample of insulin-treated individuals with T2DM exceeded the minimum criteria of 80% inter-rater agreement. RELEVANCE TO RESEARCH AND CLINICAL PRACTICE: Further psychometric testing of the scales with samples of insulin-treated individuals with diabetes is warranted and will lay the groundwork for further research and clinical practice to enhance the capability, confidence and actual performance of diabetes self-management activities among insulin-treated individuals with T2DM. CONCLUSIONS: The scales can be used by diabetes care providers to assess and follow-up individuals with diabetes who need intense case management. They also can be the measures of choice to conduct future research to test the effects of interventions among insulin-treated individuals with T2DM.

Assessment of depressive symptoms and cognitive impairment in elders from rural areas of the Brazilian State of Rio Grande do Sul.

OBJECTIVE: The main objective of this study was to examine the relationships among demographic characteristics, depressive symptoms, and cognitive impairment in oldest-old elders from rural areas of the Brazilian State of Rio Grande do Sul. DESIGN: A cross-sectional, descriptive correlational design was used to conduct the study. SAMPLE: 137 Brazilian elders age 80 years or over. MEASUREMENTS: A target population data form, a county data form, a demographic questionnaire, the Mini-Mental State Examination, and the Depressive Cognition Scale were used to collect the data. RESULTS: A significant difference was found between males and females in regard to cognitive impairment. In addition, educational level and depressive symptoms were correlated with cognitive impairment. Depressive symptoms were a weak but significant predictor of cognitive impairment after controlling for the effect of age, gender, and educational level of the oldest-old elders. CONCLUSIONS: The findings need to be interpreted cautiously since the sample scored above the cutoff points for cognitive impairment, and had low scores on depressive symptoms. Despite several limitations, findings from this study can be a foundation for further studies, and well-designed correlational or experimental approaches, are warranted.