Care Assessment Scale Research Articles

Exploring the relationship between spiritual care and patient advocacy of nurses from generations X, Y and Z working in intensive care clinics: A cross-sectional study

ObjectiveTo determine the relationship between spiritual care and patient advocacy across three generations of nurses working in intensive care units. DesignCross-sectional survey. MethodsData collection took place from July to August 2022 with 120 nurses in Turkey. Data collection tools included the Spiritual Caregiving Competency Scale, the Spirituality and Spiritual Care Assessment Scale, and the Patient Advocacy Scale for Nurses. Data on nurses’ demographics were evaluated using descriptive statistical methods (number, percentage, mean, standard deviation). Independent sample t-test, one-way ANOVA, Pearson correlation, and linear multiple regression analysis were used to evaluate the relationships between variables, with results reported as 95% confidence intervals (CI). ResultsMore than half of the nurses were from Generation Y (39.2 %) and Generation Z (42.5 %). Generation Z’s mean patient advocacy score (156.96 ± 23.16) was statistically significantly higher than Generation X’s (139.32 ± 34.26). We determined that the spiritual competence scale communication sub-dimension score of Generation Y nurses working between 1–10 years was higher than that of Generation Z nurses. Additionally, as the patient advocacy scores of all generations increased, so did spiritual competence scores. ConclusionThe study found differences in patient advocacy and spiritual care competencies between generations. Thus, we recommend organizing courses, seminars, and in-service training on patient advocacy and spiritual care for intensive care nurses. Implications for clinical practiceThis study estimates nurses’ spiritual care competencies and patient advocacy levels from different generations and sheds light on the literature to eliminate differences in care between generations in nursing practices that evolve and change over time. It is recommended that courses, seminars, in-service training, spiritual activities, and interactive meetings be organized to encourage the participation of intensive care nurses to minimize the differences in spiritual care and patient advocacy among all generations of intensive care nurses.

Frequent Error Augmentation Training in Physical Therapy Post Stroke.

The purpose of this pilot trial was to evaluate the impact of increased frequency of physical therapy sessions with error augmentation on functional mobility and disability outcomes in patients with acute stroke. We hypothesized that participants receiving frequent error augmentation physical therapy interventions (F-EA-PT) would demonstrate a higher degree of improvement on functional mobility and disability measures from admission to three post-intervention time points (treatment day 3, discharge, or 90-day follow-up). We allocated 100 individuals to receive either F-EA-PT or standard-of-care physical therapy (SOC-PT). The F-EA-PT group received physical therapy with error augmentation twice daily for 3 out of the first 5 days of hospitalization, and daily treatment sessions thereafter. Error augmentation training emphasizes impairments throughout mobility to challenge the individual, rather than facilitating normal movement patterns. The SOC-PT group received treatment once daily for 3 to 5 days per week. Assessments included National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Activity Measure for Post-Acute Care (AM-PAC) and Postural Assessment Scale for Stroke (PASS). A repeated measures mixed model approach compared treatment groups for all outcomes. The F-EA-PT group demonstrated larger magnitudes of reduction of -1.34 on NIHSS (p=0.0426) and -0.81 on mRS (p=0.0037) from admission to 90-day follow-up compared to the SOC-PT group. The F-EA-PT group demonstrated larger magnitudes of change in AM-PAC of 2.12 at treatment day 3 (p=0.0009) and 2.75 at discharge (p<0.0001) compared to SOC-PT. F-EA-PT group experienced greater improvement in PASS over the SOC-PT group with a difference in change of 4.08 at treatment day 3 (p=0.0019) and 4.45 at discharge (p=0.001). Intervening with a regimen focused on increased frequency and error augmentation from a physical therapy standpoint was safe with only one adverse event. It demonstrated significant improvements in functional outcomes post stroke above those seen with standard-of-care regimen, as evidenced by PASS and AM-PAC scores. URL: https://www.clinicaltrials.gov. Unique identifier: NCT04778475.Medical University of South Carolina IRB II Approved 04/20/2021 PRO00108635.

Application of Foot Massage Therapy to Reduce Pain Scale of Old Age with Rheumatoid Arthritis in Perumnas Public Health Center Working Area Lubuklinggau City 2023

Arthritis in RA patients causes pain, swelling, and decreased joint range of motion. It can lead to decreased independence and limited activities, reducing the quality of life. The process of foot massage also impacts the process of vasodilation and increased blood circulation. It increases the activity of the autonomic nervous system, which stimulates increased production of endorphins, which is expected to reduce pain. The case study used a descriptive method with two old older adults with Rheumatoid Arthritis, using the family nursing care assessment and pain scale assessment. The application of foot messages is carried out for 20 minutes for three days. After applying foot massage for three consecutive days, the study showed a decrease in pain intensity between before and after the intervention was given to the two subjects. The subject's pain intensity decreased from moderate pain intensity to mild pain. Applying foot massage effectively reduces the intensity of Rheumatoid Arthritis pain.

Cross-cultural adaptation and validation of the Chinese version of the intensive care oral care frequency and assessment scale

ObjectivesThe objective of this study was to translate the Intensive Care Oral Care Frequency and Assessment Scale into Chinese and to evaluate its reliability and validity in Chinese ICU patients. MethodsThis study was conducted using a cross-sectional survey design in ICUs of three tertiary hospitals in Huai'an and Taizhou from October 2022 to April 2023. The Chinese version of the Intensive Care Oral Care Frequency and Assessment Scale (C-ICOCFAS) was developed by expert consultation and cultural adaptation according to the two-person verbatim translation-back translation criteria described in the Brislin model. Item analysis was conducted using correlation analysis, and validity analysis included content validity, construct validity, and criterion validity. Reliability analyses included Cronbach's alpha coefficient, Guttman split-half reliability, and interrater reliability. ResultsThe Chinese version of the scale consisted of one dimension and nine items, consistent with the original version. Exploratory factor analysis showed KMO = 0.891, and the cumulative variance contribution reached 65.534 %. The confirmatory factor analysis indicated a good fit, χ2/df = 2.124, NFI = 0.950, GFI = 0.942, IFI = 0.973, CFI = 0.973, SRMR = 0.037, and RMSEA = 0.073. The content validity of the scale was 0.97, and the content validity of the items ranged from 0.83 to 1.00; the criterion validity was 0.969; the Cronbach's alpha coefficient was 0.919; the total item correlation coefficient was 0.725–0.831; the Guttman split-half reliability was 0.919; and the interrater reliability was 0.885. ConclusionThe C-ICOCFAS has good reliability and validity and can effectively guide nurses in the frequency of oral care for ICU patients. Implications for clinical practiceThis tool can significantly improve the level of oral care among ICU patients and further promote the health and safety of patients. These findings can help clinical nursing experts to better understand and master the use of scales and standards to improve nursing.

The effect of written document in perioperative information on the anxiety level and family-centered care of parents of children undergoing ambulatory surgery: A randomized controlled trial

PurposeTo evaluate the effect of preoperative information based on written documents on anxiety levels and the family-centered care of parents of pediatric patients who had ambulatory surgery. Design and methodsIt is a randomized controlled study. Parents were randomly divided into two groups as intervention (n = 30) and control (n = 30). Parents in the intervention group were given written document and verbal information the day before the surgery. A brochure was prepared in accordance with the verbal information describing the perioperative process as a written document. The control group was given only verbal information. Parental State Anxiety Inventory (SAI) and Family Centered Care Assessment Scale (FCCAS) were assessed before and within 1–2 h after surgery, with verbal information based on written documentation. Data were evaluated with Student's t-test for dependent and independent groups and mixed design ANOVA test for time×group interaction. Partial eta square (η2) was calculated for the effect size. ResultsThere was a significant difference between the post-intervention pretest and posttest SAI and FCCAS scores of the parents in the intervention and control groups (p < 0.05). Time group interactions anxiety and family-centered care (p < 0.001) scores had a significant and large effect size. ConclusionVerbal information supported by written documentation before pediatric ambulatory surgery can reduce parental SAI and increase parental FCCAS more than standard care. Practice implicationsProviding written document-based information to parents before surgery may be beneficial in reducing SAI and increasing FCCAS.The trial was registered in ClinicalTrials.gov (identifier: NCT05668416).

Construction and Reliability and Validity Test of Home Care Assessment Scale for Elderly Patients with Chronic Diseases Based on Intelligent Medical Care

The integration of IT with the health field has been the usual, and the introduction of AI technology in the health field will be the current mainstream in the future. General search engines can only perform superficial keyword searches, making it difficult to meet in-depth medical needs. The aging of the population is intensifying, and medical resources are in short supply. The application of remote intelligent medical care is an inevitable move. The aging of the population will lead to a reduction in the labor force, and low-end industries will face the problem of transformation and upgrading. Corporate competition has intensified, and involution has become the norm. However, chronic diseases are not contagious, but the treatment cycle is long. The purpose of this paper is to study the construction and reliability and validity of the home care assessment scale for elderly patients with chronic diseases based on tele-intelligent medical care, so as to help more patients overcome the troubles of chronic diseases. The full name of chronic disease is chronic noncommunicable disease, which does not refer to a specific disease, but to a class of onset insidious, long course of disease and the disease does not heal. It lacks definitive evidence of an infectious biological etiology. A general term for diseases with complex etiologies and some not yet fully recognized diseases. By analyzing the application requirements of intelligent medical real-time monitoring, this paper expounds the transmission function of the system. The experimental data in this paper showed that there were 15 cases of poor nursing care caused by noncompliance with doctor’s orders, accounting for 19%, indicating that patients had poor healthcare awareness and lacked necessary nursing knowledge.

Factors Related to Family Caregivers' Readiness for the Hospital Discharge of Advanced Cancer Patients.

Background: Many family caregivers of advanced cancer patients worry about being unable to provide in-home care and delay the discharge. Little is known about the influencing factors of discharge readiness. Methods: This study aimed to investigate the influencing factors of family caregivers’ readiness, used a cross-sectional survey, and enrolled 123 sets of advanced cancer patients and family caregivers using convenience sampling from four oncology wards in a medical centre in northern Taiwan. A self-developed five-point Likert questionnaire, the “Discharge Care Assessment Scale”, surveyed the family caregivers’ difficulties with providing in-home care. Results: The study showed that the discharge readiness of family caregivers affects whether patients can be discharged home. Moreover, the influencing factors of family caregivers’ discharge readiness were the patient’s physical activity performance status and expressed discharge willingness; the presence of someone to assist family caregivers with in-home care; and the difficulties of in-home care. The best prediction model accuracy was78.0%, and the Nagelkerke R2 was 0.52. Conclusion: Discharge planning should start at the point of admission data collection, with the influencing factors of family caregivers’ discharge readiness. It is essential to help patients increase the likelihood of being discharged home.

Hastanın Hasta Merkezlilik Algısı Ölçeği Türkçe Geçerlik Güvenilirlik Çalışması

Background: Patient-centeredness is one of the components of high-quality care and accepted as one of the core competencies of family medicine. The positive effect of patient-centered care on health outcomes reveals itself mainly through the patient's perception of patient-centeredness, which can be measured by the Patient Perception of Patient-Centeredness (PPPC) scale. Aims: To evaluate Turkish validity and reliability of the 18-item 'patient perception of patient-centeredness' scale (PPPC-R) developed by Stewart et al. Study Design: Methodological study. Methods: The translation of the scale was performed by three researchers with the help of 10 family medicine academicians as well as the main developers of the original scale. The Turkish form of the scale, along with the Patient-Physician Relationship summary dimension of the Primary Care Assessment Scale (PCAS) and the Patient-Doctor Relationship Questionnaire (PDRQ), was applied to 339 primary care patients. Results: The original 3-factor model of the revised Patient Perception of Patient-Centeredness (PPPC-R) questionnaire was tested with a Confirmatory Factor Analysis (CFA) to determine if the factor structure of the PPPC-R cross-validates in a Turkish patient population. The fit indices regarding the three-dimensional structure of PPPC-R are within the good or acceptable limits. The standardized factor loadings of the PPPC-R scale items ranged from 0.52 to 0.81 and t values were significant. Cronbach alpha of the scale was 0.903. With respect to criterion, the validity scale showed a negative correlation with both PCAS and PDRQ as expected. Conclusion: The three-dimensional structure of the scale was confirmed with CFA. During this verification, one item did not work and the factor load was considered to be low and removed from the scale. Turkish version of PPPC-R is a scale that can be used to evaluate patients' perception of patient-centeredness.

Translation and cultural adaptation of the Family Centered Care Assessment Scale (FCCAS) for Finnish pediatric nursing

PurposeThe purpose of this study was to translate and culturally adapt the Family Centered Care Assessment Scale (FCCAS) to evaluate family-centered care in the context of Finnish pediatric nursing. Design and methodsThe translation and cultural adaptation were done according guidelines of International Society for Pharmacoeconomics and Outcomes (ISPOR), which constitute a systematic process including ten phases. The presented research included cognitive interviews conducted with the end user of the scale: parents of hospitalized children. ResultsThe FCCAS was successfully translated and culturally adapted to the Finnish context. Translational, clinical and parental expertise were used to develop the scale. Conceptual equivalence was achieved in the translation. In the cultural adaptation, some of the items were modified based on experts' assessments to make them comprehensible and appropriate to the Finnish culture. The scale showed good evidence of content. Reporting of the study adheres to the COSMIN checklist. ConclusionsCombining ISPOR guidelines and cognitive interviews are recommended to use in the translation and cultural adaptation process. Nursing staff and parents' involvement and awareness of family-centered care have been concretized. Systematic translation and cultural adaptation have prepared a Finnish version of the scale for psychometric testing. Practice implicationsThe study outlines how rigorous methodological approaches can be applied to the translation and cultural adaptation of a measurement tool. The developed scale includes items which comprehensively cover family-centered care characteristics. In following study, it will be possible to evaluate the extent to which family-centered care is implemented in Finnish pediatric nursing.

Dahili kliniklerde yatan hastaların kronik hastalık bakımı ve sağlıklı yaşam biçimlerinin belirlenmesi

Aim: This study aimed to determine the chronic disease care and healthy lifestyles of patients hospitalized in internal medicine clinics.Materials and Methods: A descriptive and cross-sectional study was conducted from May 1 to August 31, 2019. The study population consisted of 207 patients with chronic diseases.Results: It was found that there was a statistically significant, and positively significant relationship was found between the chronic disease care assessment scale and the healthy lifestyle behaviors scale of the patients included in the study.Conclusion: Positive association was detected between care satisfaction and healthy lifestyle behaviours of individuals with chronic disease. It may be recommended to provide training that supports the healthy lifestyles of these individuals who have to live with chronic diseases.

Sustainable implementation of person-centred care in residential care facilities: hindering and supporting factors when improving incontinence care

Purpose: The aim of the present study was to focus on the impact of the implementation of a person-centred approach on staff perception of the likelihood of being able to provide person-centred care and strain in the workplace. Design: The study was a controlled prospective cohort study performed at three residential care facilities in western Sweden involving all nursing staff members active from 2013 through 2015 at baseline and at three follow-ups during and after the implementation period. Two of the residential care facilities were assigned to the intervention group and one was assigned to the control group. Method: The study was designed to test the sustainability of a person-centred approach based on three aspects: partnership, narrative and documentation. A cross-section of 20 coworkers were purposively sampled from a total of 100 persons working at the two Intervention nursing homes to participate in the intervention group. The process outcome was measured as: perceived ward atmosphere, using the staff version of the validated Person-Centred Climate Questionnaire; person-centred care, measured using the validated Person-centred Care Assessment Tool; and experience of strain in work, using the Strain in Nursing Care Assessment Scale. Descriptive statistics were calculated for all variables using the SPSS Statistics software package. Findings: The results show that, at the control site, there were lower staff perceptions of the care atmosphere, higher level of strain experienced in their work and a lower likelihood of providing a person-centred care approach, whereas these factors remained rather stable over time at the intervention residential care facilities. Two contrasting results were observed—namely, that the higher the staff's perception of the likelihood of being able to provide individualised care and of a more person-centred ward atmosphere, the higher their stress levels experienced at work. In addition, older ages and long durations of work experience significantly negatively affected the staff's assessment of their ability to create an atmosphere of everydayness and to adopt a person-centred approach in care. Conclusions: The findings show that sustainability of a person-centred ward atmosphere is possible in the care of older people, despite staffing problems and other organisational challenges, according to the staff's assessment, after implementation of a person-centred programme. The more experienced staff members assessed their likelihood of being able to provide a person-centred care as lower after the implementation phase, indicating that despite the ambition of supporting person-centredness and quality of care, staffing and management difficulties that are present at the outset of the programme's implementation can later lead to stress and frustration relating to roles and routines.

Midwives’ self-reported knowledge and skills to assess and promote maternal health literacy: A national cross-sectional survey

BackgroundLittle is known about midwives’ knowledge and skills to assess and promote maternal health literacy. AimsTo test the reliability and validity of a new tool to assess midwives’ health literacy knowledge, skills and attitudes. MethodsUsing a cross-sectional design, midwives were recruited through professional and social media networks. The online survey included demographic and professional questions and a new measure on midwives’ health literacy knowledge, skills and attitudes. Convergent validity was assessed using ten items from the Caring Assessment Scale. Perceived barriers to promoting maternal health literacy were sought. FindingsThree hundred and seven participants completed the survey. A two-factor solution accounted for 41% of variance and resulted in 14 items, including all attitude items, being removed. Cronbach’s alpha reliability was acceptable (Skills=.76; Knowledge=.66). Convergent validity was established. Most midwives (77.1%, n=221) reported giving limited attention to formally assessing women’s health literacy. Between 30 to 60% of midwives never or only sometimes used specific techniques to promote maternal health literacy. Most (75%, n=201) had not received education about health literacy. Discussion and ConclusionsThe new Transforming Maternity Care Collaborative Health Literacy tool was valid and reliable. Few midwives formally assessed or promoted women’s health literacy. Midwives require education about maternal health literacy assessment and promotion to ensure women understand information being conveyed. A large national survey of midwives using the new tool is recommended.

An investigation of foot care behavior and multiple linear regression analysis of influential factors in patients with type 2 diabetes mellitus in Jinshan District of Shanghai

Objective To investigate the level of foot care behaviors of in patients with type 2 diabetes mellitus in Jinshan District of Shanghai, analyze the influential factors, and provide information for the intervention study. Methods With convenient sampling method, a questionnaire survey was conducted with a sample of 110 inpatients with type 2 diabetes mellitus from Jinshan District of Shanghai. The investigation contents included patients′ demographic data, foot care knowledge and behaviors. The investigation tools were the questionnaire of diabetes general information, the questionnaire of foot care knowledge, and the questionnaire of foot care behaviors. Survey tools included general information questionnaire, foot care knowledge scale for diabetic patients and Nottingham Foot Care Assessment Scale in Chinese version. Independent-samples t test and oneway ANOVA were used in univariate analyses, whereas multiple stepwise linear regression was used in multivariate analyses. And Pearson correlation analysis was used to measure correlation between variables. Results The scores of foot care behaviors were statistically significant in the group comparison of sex and glycosylated hemoglobin(t=-2.142, F=3.071, P<0.05). The patients′score of foot care behaviors was (45.31±7.74) scores. 50.9 percent (54/106) patients′scores were less than 45. And the score of foot care knowledge was (16.10±4.18) scores, which was in the medium level. The foot care behaviors level was lower in the patients whose foot care knowledge was poorer (t=-5.591, P<0.01). Foot care knowledge, glycosylated hemoglobin level and gender were the main influencing factors on foot care behaviors of type 2 diabetic patients (R2=0.221, F=9.664, P=0.000). Pearson analysis demonstrated that there was a positive correlation between knowledge score, glycosylated hemoglobin level and behavior score (r=0.377, 0.207, P<0.05). Conclusions The status of foot care knowledge and behaviors of type 2 diabetic patients are not optimistic in Jinshan District of Shanghai. It′s very important to strengthen the education and management on diabetic patients′foot care knowledge and behaviors, especially in male patients. Meanwhile, the patients whose glycosylated hemoglobin are well controlled should not be ignored. Key words: Diabetic foot; Foot care behaviors; Influential factors

The Family-Centered Care Assessment Scale: Development and Psychometric Evaluation in a Turkish Sample

PurposeThe purpose of this study was to develop a family-centered care assessment scale for the parents of hospitalized children and to evaluate the psychometric characteristics of the new scale. MethodThis is a methodological study carried out in three phases. The study was conducted between on September 2017 and February 2018 with the parents of 360 children treated at the pediatric clinics of two medical faculty hospitals in Konya. Design/MethodsThe study was conducted with parents (n = 360). The data was collected via the Socio-demographic Information Form, the Family-Centered Care Scale (parallel form) and the draft scale developed by the researcher. Data was analyzed by construct validity index, exploratory and confirmatory factor analyses. End of the exploratory factor analysis FCCAS consisted of 21 items and three sub-dimensions. The content validity index was 0.92. The internal consistency coefficient (Cronbach's Alpha) was 0.94 for the total scale. The strong correlations was found between test and re-test (r = 0.90, p < .001). Confirmatory factor analysis has confirmed the three-factor structure. ConclusionIn this study developed family-centered care assessment scale (FCCAS) is a valid and reliable measurement tool. Practice implicationsThis scale can be used to evaluate family-centered care in pediatric clinics (excluding neonatal care units). It can be used as a measurement tool in descriptive and intervention studies examining family centered care.

Nursing Students, Caring Attributes, and Opportunities for Educators

Ensuring that caring individuals are graduated from colleges of nursing is necessary to meet the holistic needs of a multicultural society. Two instruments, The Nyberg’s Caring Assessment Scale and Nkongho’s Caring Ability Inventory, assessed caring attributes in pre-clinical Baccalaureate and Associate degree nursing students. Watson’s Theory of Human Caring was chosen as the theoretical foundation. Although most students had low to moderate levels of internal caring, some students in both groups possessed high levels of caring. Implications of the study suggest that caring education is needed during nursing school.

Correlates of nursing care burden among institutionalized patients with dementia.

The present study examined nursing care burden related to 55 institutionalized dementia patients using the Modified Nursing Care Assessment Scale (M-NCAS). Cognition was assessed with the Severe Impairment Battery (SIB), activities of daily living (ADLs) were measured with the Alzheimer's Disease Functional Assessment of Change Scale (ADFACS), aggression was measured with the Aggressive Behavior Scale (ABS), and the Charlson Comorbidity Index (CCI) was used to assess medical comorbidity. Finally, the Dementia Cognitive Fluctuation Scale (DCFS) was used to assess the presence and severity of cognitive fluctuations (CFs). Linear regression models were used to assess their relationships with nursing care burden. The mean age of the patients was 90.41 years (SD=2.84) and 89.10% were males. ADFACS total score (B = 0.36, β = 0.42, p = 0.002) and ABS score (B = 2.933, β = 0.37, p = 0.002) significantly predicted the M-NCAS Attitude score. ABS score was the only significant predictor of M-NCAS Strain score (B = 2.57, β = 0.35, p = 0.009). In the long-term care setting, aggressive behavior plays an important role in both subjective and objective nursing burden, while impaired ADLs increase the objective burden for nursing staff.

Validation to Spanish of the Caring Assessment Tool (CAT-V).

ResumeObjective:to translate and validate to Spanish the Caring Assessment Scale tool, CAT-V, by Joanne Duffy, within the framework of Jean Watson; as a secondary objective, it is proposed to evaluate its psychometric properties. There are tools designed to measure the patient’s perception of provided cares, including CAT-V, the subject of our interest, in a way that it can be used in Spanish-speaking patients. Methods:to meet the objectives, it was performed sequential translation and retro-translation of the scale to be validated, through a standardized procedure. The final version of that scale was validated in a sample of 349 patients from four public and two private hospitals in Madrid, Spain. Results:The instrument was translated and validated with high internal consistency (Cronbach’s alpha .953). The subsequent factor analysis revealed a three-factor structure, not coincident with the data from the US population. Conclusion:it is considered that the translation of CAT-V is a suitable instrument to be used in the evaluation of patient care in Ibero-american health centers whose language is Spanish.

Dyadic incongruence in chronic heart failure: Implications for patient and carer psychological health and self‐care

To examine whether chronic heart failure patient-carer dyads who disagree about the division of illness management tasks (incongruent) experience poorer psychosocial health and self-care, than those who agree (congruent). Informal carers often assist patients with chronic heart failure in the complex management of their illness, but little is known about how relationship dynamics may affect psychosocial health. A prospective cross-sectional study was adopted with a purposeful sample of 25 chronic heart failure patient-carer dyads residing in Australia. Data were collected via mail-out questionnaires. Dyads were classified as congruent or incongruent using the Heart Failure Care Assessment Scale. Depression, anxiety, stress and quality of life were assessed in patients and carers. Additionally, self-care and relationship quality were assessed in patients; and burden and esteem were assessed in carers. Differences in congruent and incongruent patient and carer outcomes were examined. Dyads were predominantly spousal and around a third demonstrated incongruence. No significant differences were found between congruent (n=16) and incongruent (n=9) dyads, although patients in incongruent dyads tended to have been diagnosed more recently. In chronic heart failure patient-carer dyads incongruence exists even for patients with relatively mild chronic heart failure symptoms. These findings indicate that dyadic incongruence in illness management might not affect high-functioning chronic heart failure heart failure patients or their carers. Given the prevalence of dyadic incongruence and the possibility of further negative outcomes with disease progression, it is important to examine factors such as length of time since diagnosis or type of carer relationship. By implementing self-care education and management strategies that focus on the dyad, rather than the individual, nurses have the potential to improve both patient and carer outcomes.

Elder-Clowning in Long-Term Dementia Care: Results of a Pilot Study.

To assess the effects of elder-clowning on moderate to severe behavioral and psychological symptoms of dementia (BPSD) in nursing home residents with dementia, primarily of the Alzheimer's type. Before-and-after study. Nursing home. Nursing home residents with moderate to severe BPSD, as defined according to a Neuropsychiatric Inventory-Nursing Home version (NPI-NH) score of 10 or greater (N = 23), and their care aides. A pair of elder-clowns visited all residents twice weekly (~10 minutes per visit) for 12 weeks. They used improvisation, humor, empathy, and expressive modalities such as song, musical instruments, and dance to individualize resident engagement. Primary outcomes were BPSD measured using the the NPI-NH, quality of life measured using Dementia Care Mapping (DCM), and nursing burden of care measured using the Modified Nursing Care Assessment Scale (M-NCAS). Secondary outcomes were occupational disruptiveness measured using the NPI-NH, agitation measured using the Cohen Mansfield Agitation Inventory (CMAI), and psychiatric medication use. Over 12 weeks, NPI-NH scores declined significantly (t22 = -2.68, P = .01), and DCM quality-of-life scores improved significantly (F1,50 = 23.09, P < .001). CMAI agitation scores decreased nominally, but the difference was not statistically significant (t22 = -1.86, P = .07). Occupational disruptiveness score significantly improved (t22 = -2.58, P = .02), but there was no appreciable change in M-NCAS scores of staff burden of care. Results suggest that elder-clowning reduced moderate to severe BPSD of nursing home residents with dementia, primarily of the Alzheimer's type. Elder-clowning is a promising intervention that may improve Alzheimer's disease care for nursing home residents.

Nurse Educators’ Perceptions of Caring Attributes in Current and Ideal Work Environments

Abstract AIM The study explored nurse educators' perceptions of the frequency (experience) of caring attributes in their current work environments and the attributes' importance (expectation) in an ideal work environment. BACKGROUND Caring has been linked to only a few components of nurse educators' work satisfaction. However, its influence may be much greater. METHOD A multisite convenience sample (N = 241) completed an adapted version of the Nyberg Caring Assessment Scale©. Paired t-tests, correlations, and content analysis were used to explore experience-expectation gaps RESULTS Significant and substantive (p < .01, r ≥ .50) experience-expectation gaps and correlations (p < .05) between demographic and work environment characteristics and caring attributes were found. Sources of and opportunities for caring attributes were identified. CONCLUSION The findings suggest that feeling valued contributes to nurse educators' perceptions of a positive work environment and may inform recruitment and retention st...