Spirituality and self-efficacy in dementia family caregiving: trust in God and in yourself

Equipping Families and Friends to Offer Spiritual Care to People Living with Dementia: Findings from a Meta-Synthesis

Our work presents a meta-synthesis of 76 peer-reviewed, qualitative-research journal articles related to our research interest in the spiritual care training available for relatives and friends of people living with dementia. A total of 244 articles was reviewed prior to the application of selection criteria. The final sample of 2698 research participants across our selection of 76 peer-reviewed qualitative-research studies serves to demonstrate the value of spiritual care as an aspect of holistic palliative and dementia care. The development and implementation of spiritual-care standards and practices in healthcare generally is increasingly widespread. Most current training resources are designed for healthcare professionals, and our meta-synthesis identifies the need for training resources that equip and train volunteer spiritual carers, namely, the relatives and friends of people living with dementia. Our meta-synthesis suggests there is a need to develop training resources that equip relatives and friends with skills that prioritise attentive presence, spiritual intelligence, emotional intelligence, and, primarily, sensory spiritual practices. Beyond this meta-synthesis, developing and trialling suitable training materials and events will become the focus of an action research project.

The Effects of a Psychosocial Support Program on Perceived Stress of Family Caregivers of Patients with Mental Disorders

Background:

Taking caring of patients with mental disorders is stressful and people who take care of these patients need to receive enough support and training to overcome this challenging situation. The present study was aimed at investigating the effects of a psychosocial support program on perceived stress of family caregivers of patients with mental disorders.

Materials and Methods:

This randomized controlled clinical trial was performed on 64 family caregivers of patients with mental disorders referred to Noor and Hazrat-e-Ali Asghar hospital in Isfahan, Iran, in 2018-19. The participants were randomly assigned to the intervention and control groups using a random number table. In the intervention group, the training program was held in 6 sessions of 90-minute training classes twice a week. Data were collected using a demographic characteristics form and the Perceived Stress Scale (PSS) before, immediately after, and 1 month after the intervention. Descriptive and inferential statistical tests such as Chi-square, Mann-Whitney, independent t-test, repeated measures ANOVA, and Kolmogorov-Smirnov test were used to analyze the data in SPSS software.

Results:

The result of the study showed that the total mean score of perceived stress in the intervention group was significantly less than the control group immediately after (F₂=66.29, p<0.001) and 1 month after the intervention (F₂=66.29, p<0.001).

Conclusions:

Delivering a training program on the different dimensions of support family caregivers need will reduce the perceived stress of family caregivers of patients with mental disorders. Therefore, the implementation of this intervention is recommended in this group of caregivers.

Development and Evaluation of the 8-item Caregiver Self-Efficacy Scale (CSES-8)

BACKGROUND AND OBJECTIVES

This paper describes the development and evaluation of a short caregiving self-efficacy measure. The self-administered 8-item Caregiver Self-efficacy Scale (CSES-8) was developed to reflect components of typical caregiver-support interventions and to be practical for inclusion in future self-efficacy and caregiving research.

RESEARCH DESIGN AND METHODS

We administered the CSES-8 in two samples: participants in an intervention for caregivers of persons with cognitive disabilities, and a voluntary on-line survey for caregivers of adults. We evaluated the completion rate, item-scale correlations, reliability, descriptive statistics, and preliminary construct validity of the CSES-8 in both samples, and sensitivity to change in the intervention sample.

RESULTS

The intervention caregivers' sample (N=158) was 85% female (mean age=65 years). The on-line survey sample (N=138) was 90% female (mean age=78). In both samples, the CSES-8 had excellent internal-consistency reliability (0.89 and 0.88) and good distribution with sufficient variability to detect change. Test-retest reliability was good in the on-line sample (0.73). As evidence of construct validity, most hypotheses were confirmed in both samples. The CSES-8 was sensitive to change at 6 months for caregivers in the intervention program (p < .001).

DISCUSSION AND IMPLICATIONS

The CSES-8 is short, comprehensive with respect to common components of interventions to improve caregivers' quality of life, and sensitive to change. It can serve a useful role exploring mechanisms by which caregiver intervention studies work, and it can be helpful in examining whether self-efficacy mediates the effect of these intervention on various outcomes such as psychological well-being.

The challenges of dementia care and the (un)making of meaning: Analysis of an online forum on carer spirituality

Although one writer has called dementia ‘the theological disease’, there has been remarkably little research on how people with dementia and their carers find spiritual meaning and significance in their experience. While there is a significant body of literature examining the role of existing spiritual or religious beliefs and practices in supporting the carer of a person with dementia, there is very little research which offers an insight into the reverse process: how the experience of caring challenges a carer’s sources of spiritual or religious meaning, and what strategies are adopted to resolve the experienced tension between belief and experience. The present study aimed to supplement this incomplete picture by examining the archive of an online forum responding to a request for ‘thoughts which lend a spiritual perspective to going through dementia’. Interpretative Phenomenal Analysis (IPA) was undertaken on two levels. First, attention was focussed on the forum as an integrated discussion, identifying its recurrent and superordinate themes. The contributions of selected individual participants were then analysed to further examine the way in which their positions were developed. The analysis uncovered the importance which at least some carers of people with dementia attached to spiritual perspectives, as supplying strength for and meaning to the challenges they faced; but also how meaning was undermined by their experience. Few participants identified with traditional religious resources, but attempted to find meaning by reflection on their personal narrative. Six distinct types of response to the initial question were identified. These findings indicate that the wellbeing and resilience of at least some carers may benefit from validation of their spiritual concerns along with sensitive and attentive spiritual support. In this task, a key resource is their reflection on their personal narrative in relation to current challenges.

Self-reassurance and self-efficacy for controlling upsetting thoughts predict depression, anxiety, and perceived stress in help-seeking female family caregivers

OBJECTIVES

Providing care for an older family member is a common experience for women and has been linked with increased depression, anxiety, and stress for some caregivers. This study aimed to investigate the role of self-reassurance and self-efficacy for controlling upsetting thoughts in mitigating the negative effects of caregiving stressors on mental health.

DESIGN

Measures were collected during a pre-intervention assessment for a larger study in the U.S.A. evaluating online interventions for intergenerational caregivers. Hierarchical linear regressions were used to examine the contribution of self-reassurance and self-efficacy for controlling upsetting thoughts on mental health outcomes, after controlling for caregiving-related contextual variables and stressors.

SETTING

Participants completed online questionnaires on a computer or tablet at their convenience.

PARTICIPANTS

Participants were 150 help-seeking adult women providing health-care assistance to older relatives living in the community.

MEASUREMENTS

Measures were completed for the mental health outcomes of depression, anxiety, and stress. Measures also included contextual factors of caregiving and demographics. Cognitive impairment, caregiver assistance, role overload, percentage of care provided, family conflict, self-reassurance, and self-efficacy for controlling upsetting thoughts were also measured.

RESULTS

Regression models revealed that both self-reassurance and self-efficacy for controlling upsetting thoughts predicted depression, anxiety, and perceived stress after controlling for caregiving contextual factors and stressors.

CONCLUSIONS

The results indicate that self-reassurance and self-efficacy for controlling upsetting thoughts are effective resources linked to mental health outcomes. Although results were obtained with cross-sectional data, these findings suggest the potential of targeting these resources in transdiagnostic interventions for family caregivers.

Spiritual Orientation, Meaning in Life, Life Satisfaction, and Well-Being in Mothers with Disabled Children

This study was planned in order to investigate the relationship between spiritual orientation with meaning in life, life satisfaction and well-being in mothers with disabled children. The research was carried out with 128 mothers in a private rehabilitation center at eastern Turkey. The Spiritual Orientation Scale (SOS), Meaning in Life Questionnaire (MLQ), Life Satisfaction Scale (LSS), and Well-Being Index (WBI) were used in the data collection. The mean score of the mothers on the SOS was found to be high (89.34 ± 7.14). It was determined that as the mean scores of mothers on the SOS increased, their mean scores on MLQ, LSS, and WBI increased and that the relationship between them was significant (p < 0.05). It was found that as the spiritual orientation of the mothers increased, meaning in life, life satisfaction, and well-being increased as well.

DETERMINING FACTORS IN THE SITUATIONAL TRANSITION OF FAMILY MEMBERS WHO CARE OF ELDERLY PEOPLE WITH PARKINSON'S DISEASE

ABSTRACT Objective: to investigate the facilitator and inhibitory factors in the transition of elderly caregivers with Parkinson's disease. Method: a qualitative, exploratory and descriptive study, based on the family transition nursing theory developed with 20 elderly caregivers of elderly people with Parkinson 's disease, enrolled in the Associação Parkinson de Santa Catarina, from March to August 2015. To analyze and interpret the data, we used the thematic analysis of content proposed by Bardin, with the help of the ATLAS.ti software for data organization. Results: some factors were identified and considered as facilitators for the process of transition from the familiar to the exercise of the role of caregiver, such as: previous experiences as caregiver; spirituality and religiosity; family support network and health services. Other factors were identified as inhibiting factors for transition: emotional and physical health conditions; advanced age; personal life activities/commitments; family financial burden; and inadequate family support. It was observed that most family caregivers reported having previous experience in caring, having advanced age, and being able to care for the elderly with the disease. However, he considers his condition of emotional and physical health insufficient, resulting in overload. Lack of access to health services and family and financial support make it difficult to provide care. Conclusion: nurses should seek strategies to direct attention to facilitating factors in the family context in order to help the family to achieve well-being and healthy transition to the role of caregiver.

Spiritual Transcendence and Psychological Adjustment: The Moderating Role of Personality in Burn Patients

The current study examined the moderating role of personality traits (neuroticism and extraversion) on the relationship between spiritual transcendence and positive change, and spiritual transcendence and distress in burn patients. The sample (N = 98) comprised adult burn patients (age = 25-50) admitted to three hospitals in Lahore, Pakistan. They were assessed according to a demographic information sheet, the NEO Personality Inventory (McCrae and Costa in J Personal Soc Psychol 52:81-90, 1987), the Spiritual Transcendence Index (Seidlitz et al. in J Sci Study Relig 41:439-453, 2002), the Depression, Anxiety, Stress Scales-21 (Lovibond and Lovibond in Manual for the Depression Anxiety Stress scales, Psychology Foundation, Sydney, 1995), and the Perceived Benefit Scales (McMillen and Fisher in Soc Work Res 22(3):173-186, 1998). Stepwise moderated regression analysis showed that both personality traits (neuroticism and extraversion) played a moderating role in the relationship between spiritual transcendence and positive change, and spiritual transcendence and distress in burn patients. The findings highlight the potential role spiritual transcendence may have in understanding and improving the psychological adjustment of burn patients.

Caregiver Reactions to Dementia Symptoms: Effects on Coping Repertoire and Mental Health

Currently, 15 million informal caregivers, most of whom are women, provide care for older adults with dementia (Alzheimer's Disease Association, 2016). Caregiving for these individuals often creates distress and may adversely affect female caregivers' psychosocial and spiritual well-being. Approximately 35% of dementia caregivers complain of health deterioration after initiating caregiving responsibilities as compared to 19% of caregivers of older adults who do not have dementia (Alzheimer's Disease Association, 2016). Persons with dementia exhibit symptoms and behaviors that often are challenging for their caregivers. The way that caregivers react to these symptoms and behaviors may affect their coping repertoire and their mental health. Adequate evaluation of caregiver reactions to symptoms of dementia will provide information useful for developing targeted interventions to promote optimal health of female dementia caregivers and to potentially postpone the need for nursing home or long-term placement of the care recipient.

Validating the Revised Scale for Caregiving Self-Efficacy: A Cross-National Review

Background and Objectives

This article reviews an instrument used in cross-national research with dementia family caregivers—the Revised Scale for Caregiving Self-Efficacy (RSCSE). Although the RSCSE has been translated into multiple languages, few studies have examined scale performance across samples. We examine congruence of psychometric, reliability, and validity data to inform research and practice.

Methods

We conducted citation searches using Scopus, Google Scholar, Web of Science, and PsycINFO. Identified dementia caregiving studies cited the original RSCSE article and described results of English and/or non-English translations of the scale.

Results

Peer-reviewed published studies (N = 58) of dementia family caregivers included data for Arabic, Chinese, English, French, Italian, and Spanish translations of the RSCSE; the majority (72%) reported use of non-English translations. Studies utilizing confirmatory factor analytic approaches reported findings consistent with the original development study. Internal consistency, convergent/discriminant validity, and criterion validity indices were congruent across diverse cross-national caregiving samples assessed with different translations. Data supported the RSCSE’s sensitivity to change following specific psychosocial caregiving interventions.

Discussion

The reliability and validity of different translations of the RSCSE support continued use with cross-national samples of dementia family caregivers. Limitations of the scale point to the need for further self-efficacy measurement development within caregiving domains. Consistent with Bandura’s discussion of social cognitive theory in cultural contexts, personal agency for caregiving challenges remains generalizable to cross-national populations. This review discusses the implications for cross-cultural research and practice.

Qualitative Analysis of Faith Community Nurse-Led Cognitive-Behavioral and Spiritual Counseling for Dementia Caregivers

This article presents themes emerging from semistructured interviews with dementia family caregivers in rural communities who participated in an integrative, cognitive-behavioral and spiritual counseling intervention, and with faith community nurses (FCNs) who delivered the intervention. The primary objectives of the counseling intervention were to ameliorate dementia caregivers' depressive affect and the severity of their self-identified caregiving and self-care problems. The qualitative portion of the study was intended to elicit caregivers' and FCNs' perceptions of the benefits and drawbacks of the intervention. We conducted interviews with seven FCN/caregiver pairs 4 times during the 6-month counseling process, totaling 56 interviews. Themes emerging from the interviews included caregivers' perception of burden and care partners' problem behavior; formation of therapeutic alliance between FCNs and caregivers; problem-solving skills, tools, and resources; caregivers' use of problem-solving strategies; spirituality in caregiving and counseling processes; FCNs' prior professional experience; and caregiver and FCN time constraints.

Anxiety and Spiritual Well-Being in Nursing Students: A Cross-Sectional Study

Purpose: To analyze the relation between anxiety and spiritual well-being in undergraduate nursing students. Design: Cross sectional, correlational, and survey design. Method: A total of 169 students from a Brazilian Nursing School completed three instruments: demographic data, Spiritual Well-Being Scale (SWBS), and Beck Anxiety Inventory (BAI). Findings: The mean score of SWBS was high, and the mean score of BAI was low. When experiencing anxiety, there was lower probability of experiencing high spiritual well-being. For those students considering religiosity very important, the score of SWBS was high. Students scoring lower in SWBS had more probability of experiencing moderate/high anxiety. Conclusions: Higher scores of SWBS and importance given to religiosity were related to lower scores of BAI. Also, the performance and score of spiritual well-being were related to anxiety scores. Further research is worthy to identify and validate which educational aspects could promote spiritual well-being and reduce anxiety as well as research to analyze the relation between spiritual well-being score and learning outcomes.

Factors influencing changes in health related quality of life of caregivers of persons with multiple chronic conditions

Background

The majority of care for older adults with multiple chronic conditions (MCC) is provided by family (including friends) caregivers. Although caregivers have reported positive benefits to caregiving they also experience decreases in their physical and mental health. As there is a critical need for supportive interventions for this population, it is important to know what influences the health of family caregivers of persons with MCC. This research examined relationships among the changes from baseline to 6 months in health related quality of life (SF12v2) of family caregivers caring for older adults with multiple chronic conditions and the following factors: a) demographic variables, b) gender identity [Bem Sex Role Inventory (BSRI)] c) changes in general self-efficacy [General Self Efficacy Scale (GSES) (baseline to 6 months) and d)) changes in caregiver burden [Zarit Burden Inventory (ZBI)] baseline to 6 months. Specific hypothesis were based on a conceptual framework generated from a literature review.

Methods

This is a secondary analysis of a study of 194 family caregivers who were recruited from two Canadian provinces Alberta and Ontario. Data were collected in-person, by telephone, by Skype or by mail at two time periods spaced 6 months apart. The sample size for this secondary analysis was n = 185, as 9 participants had dropped out of the study at 6 months. Changes in the scores between the two time periods were calculated for SF12v2 physical component score (PCS) and mental component score (MCS) and the other main variables. Generalized Linear Modeling was then used to determine factors associated with changes in HRQL.

Results

Participants who had significantly positive increases in their MCS (baseline to 6 months) reported lower burden (ZBI, p < 0.001), and higher general self-efficacy (GSES, p < 0.001) and Masculine BSRI (p = 0.025). There were no significant associations among variables and changes in PCS (baseline to 6 months).

Conclusions

Our findings suggest that a masculine gender identity (which incorporates assertive and instrumental approaches to caregiving), and confidence in the ability to deal with difficult situations was positively related to improvement in mental health for caregivers of persons with MCC. Decreases in perceptions of burden in this populations was also associated with improvements in mental health. Further research is needed to explore ways to support caregivers of older persons with multiple chronic conditions living at home.

Smoking and Smoking Increase in Caregivers of Alzheimer's Patients

PURPOSE OF THE STUDY

The relationship between stress and smoking has been established, but there is little research on the effects of stress and coping on smoking in caregivers of Alzheimer's disease patients. This study examines how caregiver stressors and coping resources explain smoking status and recent smoking increase.

DESIGN AND METHODS

Data were obtained from the Resources for Enhancing Alzheimer's Caregivers Health (REACH II) study. Analyses identified differences between caregiver smokers and nonsmokers and between caregiver smokers who reported a recent smoking increase and those who did not. Variables that were significantly different between the groups were examined in two logistic regression analyses to explain smoking status and smoking increase.

RESULTS

Of 642 caregivers, nearly 40% reported smoking and 25% of smokers reported recent increase in smoking. Younger caregivers were more likely to report smoking. Explanatory variables for smoking increase were being Caucasian or African-American, higher depression scores, and less caregiving skills.

IMPLICATIONS

This study demonstrates that smoking among caregivers is a valid public health concern. Further investigation of ways that explanatory variables affect smoking status and increase in caregivers, and incorporation of smoking cessation strategies that address depression and low caregiving skills, seem warranted in future caregiver interventions.

Caregiver health: health of caregivers of Alzheimer's and other dementia patients

Alzheimer's disease (AD) is the most common type of dementia and is a significant public health problem that will intensify as the population ages. The behavioral and psychological symptoms of dementia (BPSD) present a significant burden to patients, their families, and their caregivers. The majority of care is provided at home by family caregivers. Caring for a person with AD and other dementias is associated with significant risk to the caregiver's health and well-being. Healthcare providers must recognize that family caregivers often present as secondary patients. Given the importance of these caregivers to patients with AD and other dementias, it is vital to understand the risk factors that impact caregiver health and well-being. Non-pharmacological interventions can reduce the negative impact of caregiver burden on caregiver health, reduce premature institutionalization of patients, and improve quality of life for patients, their families, and their caregivers. This article summarizes recent relevant research concerning AD and dementia caregiver health and psychosocial interventions.