1
|
Chen MC, Palmer MH, Lin SY. SOURCE, a learned resourcefulness program to reduce caregiver burden and improve quality of life for older family caregivers. Int J Older People Nurs 2024; 19:e12588. [PMID: 37950534 DOI: 10.1111/opn.12588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/28/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Family members often undertake caregiving responsibilities over long periods of time, which could lead to caregiving burden. A theory-based and culturally sensitive learned resourcefulness program may help family caregivers mitigate stress by learning and using self-help strategies. OBJECTIVES This study's aim is to use rigorous methods to investigate the effects of a learned resourcefulness program called SOURCE (Chen et al., Geriatric Nursing, 2021, 45, 1129) to reduce caregiver burden and improve quality of life (QOL) for family caregivers. SOURCE is an acronym for the six self-help behaviors at the core of this theory-based learned resourcefulness program, developed by the Principal Investigator (PI) in collaboration with other researchers (Chen et al., Geriatric Nursing, 2021, 45, 1129). These behaviors are: seeking problem-solving strategies, organizing daily actions, using self-regulation, reframing positive situations, changing negative self-thinking, and exploring new thinking and skills. METHODS We used a quasi-experimental design with repeated measures for this study. The potential subjects were family caregivers whose family member was receiving home care. PI recruited 94 family caregivers (60 years old or older) who were caring for disabled and/or ill family members who also were 60 years old or older and living at home at the time of the study. The PI recruited these caregivers through the home care services department of a hospital and two community healthcare centers in Taiwan. The experimental group (n = 46) received the four-week in-person SOURCE while their family member continued to receive home care services, whereas the control group (n = 48) did not receive the SOURCE program while their family member received home care services. We collected data from the participants using the Caregiver Burden Scale, EuroQol-5 Dimension, and Rosenbaum's Self-Control Scale at baseline (T0, Week 1), after the intervention (T1, Week 5), and at follow-up (T2, Week 9). We analyzed the data using paired-sample t-tests and used the generalized estimating equation method to compare paired data between the baseline and follow-up. RESULTS Of the 94 recruited family caregivers, 90.4% (n = 85) completed the study. We found no significant differences between the experimental and control groups in terms of demographic, caregiver burden, and QOL variables at baseline. Compared to the control group, the experimental group had significantly improved caregiver burden scores (indicating a reduction in caregiver burden) at the end of the intervention and at follow-up. The experimental group had significantly improved QOL scores at follow-up only. The experimental group also showed high levels of adherence to and satisfaction with the intervention. The paired-sample t-test results show significantly improved learned resourcefulness between T0 and T1 and between T0 and T2 (t = -5.84, p < 0.001; t = -6.77, p < 0.001) for the experimental group. CONCLUSION The SOURCE program helped family caregivers develop and use self-help behaviors during their daily caregiving tasks. The family caregivers reported satisfaction with the program as well as reduced caregiver burden and improved QOL after the program ended. IMPLICATIONS FOR PRACTICE The SOURCE program can be implemented to improve family caregivers' caregiver burden and QOL. Community health nurses can improve self-help abilities of family caregivers by helping them to acquire abilities and skills that allow them to effectively handle stress and reduce their caregiver burden.
Collapse
Affiliation(s)
- Meng-Chun Chen
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - Mary Happel Palmer
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shu-Yuan Lin
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| |
Collapse
|
2
|
Wen M, Liang Y, Shen Q, Yu J, He P, OuYang X, Zauszniewski JA. Effects of Teaching Resourcefulness in Patients with Coronary Heart Disease. West J Nurs Res 2021; 44:874-885. [PMID: 34098821 DOI: 10.1177/01939459211020757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This cluster randomized controlled trial aimed to investigate the effects of an intervention to teach resourcefulness on depression and coping style of patients with coronary heart disease (CHD). A convenience sample of 72 patients in community settings took part. Participants in the intervention group (n = 36) received an 8-week intervention based on the concept of resourcefulness, plus routine health education. Participants in the control group (n = 36) received routine health education only. After the intervention, participants in the intervention group had significantly higher scores on resourcefulness and coping styles, and lower scores on depression than those in the control group (both ps < .001). The findings suggest that a well-developed intervention to teach resourcefulness could help patients with CHD to be more resourceful, improve their level of depression, and choose more effective strategies to cope with stress.
Collapse
Affiliation(s)
- Min Wen
- School of Nursing, University of South China, Hengyang, P.R. China
| | - Yaqin Liang
- Medical College of Shaoguan University, Shaoguan, P.R. China
| | - Qianqian Shen
- School of Nursing, University of South China, Hengyang, P.R. China.,The Second Affiliated Hospital of Jiaxing University, Second Hospital of Jiaxing, Jiaxing, Zhejiang Province, China
| | - Juping Yu
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Pingping He
- School of Nursing, University of South China, Hengyang, P.R. China.,School of Nursing, Institute of Cardiovascular Disease, Key Laboratory for Ateriosclerology of Hunan Province, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, P.R. China
| | - Xinping OuYang
- Department of Physiology, Institute of Neuroscience, Hengyang Key Laboratory of Neurodegeneration and Cognitive Impairment, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Research, Hengyang Medical College, University of South China, Hengyang, P.R. China
| | - Jaclene A Zauszniewski
- Community Health Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
3
|
Hayslip B, Fruhauf CA, Dolbin-MacNab ML. Grandparents Raising Grandchildren: What Have We Learned Over the Past Decade? THE GERONTOLOGIST 2020; 59:e152-e163. [PMID: 28666363 DOI: 10.1093/geront/gnx106] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In this manuscript, we update the literature over the last decade in addressing several new content areas that have emerged in the grandfamilies literature, along with issues that are still important to understanding grandparents raising their grandchildren today. RESEARCH DESIGN AND METHODS The social science and gerontological literature since 2004 was accessed, reviewed, organized topically, and integrated, based upon an exhaustive PsychINFO literature search. RESULTS Our review indicates an ongoing and/or growing emphasis on (a) the strengths of grandparent raising grandchildren, (b) diversity among grandfamilies along a number of parameters, (c) the social-interpersonal, cultural, and policy-related contexts of grandfamilies, (d) process-focused research, (e) parenting, parenting skills, and family relationships, (f) grandparent psychological distress, (g) targets for and the efficacy of interventions with grandfamilies, and (h) methodological issues relevant to the study of grandfamilies. IMPLICATIONS We discuss the implications of our findings in terms of more completely understanding grandfamilies along a number of parameters, as well as presenting specific recommendations for future research and practice.
Collapse
Affiliation(s)
- Bert Hayslip
- Department of Psychology, University of North Texas, Denton
| | - Christine A Fruhauf
- Department of Human Development and Family Studies, Colorado State University, Ft. Collins
| | | |
Collapse
|
4
|
Kelley SJ, Whitley DM, Campos PE. Differential Impact of an Intervention for Grandmothers Raising Grandchildren. JOURNAL OF INTERGENERATIONAL RELATIONSHIPS 2019. [DOI: 10.1080/15350770.2018.1535351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Susan J. Kelley
- College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Deborah M. Whitley
- School of Social Work, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
| | | |
Collapse
|
5
|
Zauszniewski JA, Bekhet A, Herbell K. Comprehensive evaluation of interventions: eight vital parameters. Nurse Res 2018; 26:20-25. [PMID: 30474362 DOI: 10.7748/nr.2018.e1603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is critically important to determine the effectiveness of an intervention before it can be translated into clinical practice. However, the future implementation and sustainability of the intervention may be diminished if other intervention parameters are not assessed. This requires obtaining feedback from intervention recipients so interventions will be perceived as appealing, relevant, meaningful and beneficial to them; otherwise recipients may be unlikely to perform them over time, resulting in unsuccessful health outcomes. AIM To propose the addition of two intervention parameters to the existing six-parameter model and provide examples from recent research of how each parameter can be tested. DISCUSSION Definitions of the eight parameters are provided and methods for analysing each of them explained. While some studies show necessity, fidelity and cost have unique distinguishing characteristics, other studies indicate feasibility, acceptability and safety have common features, and efficacy and effectiveness are closely associated. CONCLUSION Researchers frequently examine one or two parameters, but few simultaneously apply the six-parameter model. This model is also missing two vital parameters - efficacy and cost. IMPLICATIONS FOR PRACTICE Comprehensive and systematic evaluation of all eight intervention parameters is recommended before researchers begin randomised controlled trials and translate them into practice.
Collapse
Affiliation(s)
| | - Abir Bekhet
- Marquette University, Milwaukee, Wisconsin, United States
| | - Kayla Herbell
- Sinclair School of Nursing, University of Missouri, United States
| |
Collapse
|
6
|
Toly VB, Blanchette JE, Musil CM, Zauszniewski JA. Journaling as reinforcement for the resourcefulness training intervention in mothers of technology-dependent children. Appl Nurs Res 2016; 32:269-274. [PMID: 27969041 DOI: 10.1016/j.apnr.2016.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/12/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022]
Abstract
Resourcefulness, a set of cognitive and behavioral skills used to attain, maintain, or regain health, is a factor related to depressive symptoms in mothers of children with chronic conditions and complex care needs who are dependent on medical technology such as mechanical ventilation or feeding tubes. The purpose of this secondary analysis of a randomized, controlled pilot intervention study was to determine the feasibility, acceptability and fidelity of daily journal writing as a method of reinforcement of resourcefulness training (RT) that teaches the use of social and personal resourcefulness skills. Participants returned their journals to the study office at the end of the four-week journaling exercise. Content analysis from exit interviews and journals supported the feasibility, acceptability and fidelity of daily journaling for reinforcement of RT in this population. Journal writing can be used by pediatric nurses to reinforce and promote resourcefulness skill use in parents of technology-dependent children.
Collapse
Affiliation(s)
- Valerie Boebel Toly
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA, 44106.
| | - Julia E Blanchette
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA, 44106.
| | - Carol M Musil
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA, 44106.
| | - Jaclene A Zauszniewski
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA, 44106.
| |
Collapse
|
7
|
Musil CM, Zauszniewski JA, Burant CJ, Toly VB, Warner CB. Evaluating an Online Resourcefulness Training Intervention Pilot Test Using Six Critical Parameters. Int J Aging Hum Dev 2016; 82:117-35. [DOI: 10.1177/0091415015623552] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Few resources are available to help grandmother caregivers to grandchildren manage their complex family situations that may have immediate and long-term consequences for themselves and their families. Resourcefulness training is an intervention designed to help grandmothers improve their ability to deal with these problems. The purpose of this pilot study was to evaluate the necessity, feasibility, acceptability, fidelity, safety, and effectiveness (i.e., effect sizes) of an online, computer-based resourcefulness training intervention that was adapted from a face-to-face intervention. Twelve grandmothers raising or living with grandchildren participated in the pilot intervention that included (a) watching an instructional video on resourcefulness, (b) completing two online questionnaires over a 6-week time period, and (c) writing in an online journal every day for 4 weeks. Data are evaluated within the context of the six parameters important to intervention development. Qualitative and quantitative results provide initial support for all six parameters. Recommendations to improve aspects of the intervention are discussed.
Collapse
Affiliation(s)
- Carol M. Musil
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Christopher J. Burant
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
- Cleveland Louis Stokes VA Medical Center, Geriatric Research, Educational, Clinical Center, Cleveland, OH, USA
| | - Valerie B. Toly
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Camille B. Warner
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
8
|
Zauszniewski JA, Lekhak N, Napoleon B, Morris DL. Resourcefulness Training for Women Dementia Caregivers: Acceptability and Feasibility of Two Methods. Issues Ment Health Nurs 2016; 37:249-56. [PMID: 26980158 PMCID: PMC4841246 DOI: 10.3109/01612840.2015.1119222] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Almost 10 million women in the United States are caregivers for elders with dementia and many experience extreme stress that compromises their health. Acceptable and feasible interventions to teach them resourcefulness skills for managing stress may improve their health and facilitate continued caregiving. This study examined two commonly used methods for practicing skills taught during resourcefulness training (RT) to women caregivers of elders with dementia (n=63): journaling and digital voice recording. It also explored whether providing caregivers a choice between the two methods made it more acceptable or feasible. Qualitative and quantitative data were collected before, during, and after RT. Caregivers who recorded used more words (M=5446) but recorded fewer days (M=17) than those who journaled (M=2792 words and M=27 days). Similar concerns in relation to time management and practice method were expressed by women caregivers irrespective of practice method (journal versus recorder) or random versus choice condition. While journaling was more frequent than recording, more words were expressed during recordings. Perceived stress and depressive symptoms were unrelated to the number of practice days or word counts, suggesting RT acceptability and feasibility even for highly stressed or depressed caregivers. Because intervention feasibility is important for RT effectiveness testing, alternatives to the journaling and recording methods for practicing RT skills should be considered.
Collapse
Affiliation(s)
| | - Nirmala Lekhak
- b Case Western Reserve University , Cleveland , Ohio , USA
| | - Betty Napoleon
- c Case Western Reserve University , Nursing, Cleveland , Ohio , USA
| | - Diana L Morris
- c Case Western Reserve University , Nursing, Cleveland , Ohio , USA
| |
Collapse
|
9
|
Dumela Mma: an examination of resilience among South African grandmothers raising grandchildren. AGEING & SOCIETY 2015. [DOI: 10.1017/s0144686x15001014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTGrandmothers serve as primary care-givers for a significant number of South African children. Previous research has documented that South African grandmothers experience physical, financial, emotional and social adversity. However, less attention has been given to South African grandmothers' resilience, or their capacity to respond to the challenges associated with raising their grandchildren. Utilising Walsh's (2003; 2012) family resilience model, this qualitative study examined resilience and resilient processes among 75 Black South African grandmothers raising grandchildren. Grandmothers participated in structured interviews during a weekly visit to a local luncheon (social) club. Results indicated that the grandmothers perceived themselves as engaging in a number of resilient processes, including relying on their spirituality, accessing sources of instrumental support, and seeking emotional support and companionship from their grandchildren and larger communities. Grandmothers also believed that focusing on their grandchildren contributed to their sense of resilience. This involved maintaining a sense of responsibility to their grandchildren, having hope for their grandchildren's futures and finding enjoyment in the grandmother–grandchild relationship. The findings reveal that, by engaging in various resilient processes, South African grandmothers raising grandchildren perceive themselves and their families as having strategies they can utilise in order to successfully cope with adversity. Findings also highlight the need for prevention and intervention efforts designed to promote grandmothers' resilience, as well as the resilience of their grandchildren.
Collapse
|
10
|
Zauszniewski JA, Musil CM. Interventions for Grandmothers: Comparative Effectiveness of Resourcefulness Training, HRV Biofeedback, and Journaling. ACTA ACUST UNITED AC 2014. [DOI: 10.5298/1081-5937-42.3.03] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the United States, more than one million grandmothers are raising their grandchildren, and this can be stressful, produce depressive symptoms, and adversely affect their quality of life. The pilot trial of 60 grandmothers reported here examined the effects of a cognitive behavioral intervention (resourcefulness training), biofeedback control training (focused on heart rate variability), and journaling on measures of perceived stress, depressive symptoms, and quality of life. Comparative analysis revealed a decrease in stress with all three conditions; a decrease in depressive symptoms in the resourcefulness training group; and improved quality of life in the resourcefulness training and biofeedback groups.
Collapse
Affiliation(s)
| | - Carol M. Musil
- Marvin E. Denekas and Ruth Durr Denekas Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| |
Collapse
|
11
|
Zauszniewski JA, Musil CM, Burant CJ, Standing TS, Au TY. Resourcefulness training for grandmothers raising grandchildren: establishing fidelity. West J Nurs Res 2014; 36:228-44. [PMID: 23982519 PMCID: PMC3947390 DOI: 10.1177/0193945913500725] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over one million American grandmothers raise grandchildren, and many experience stress that adversely affects their mental health. Teaching resourcefulness skills can minimize this stress. However, before testing effectiveness of resourcefulness training (RT), its fidelity must be established. This pilot intervention trial examined the fidelity of two methods of RT: expressive writing (journaling) and verbal disclosure (voice recording) using a quasi-experimental design with random assignment of 80 grandmothers to RT-expressive writing, RT-verbal disclosure, or expressive writing or verbal disclosure alone. Quantitative data (Resourcefulness Scale) and qualitative data (journals, recordings) were collected. Grandmothers with RT showed greater resourcefulness over time than those without RT, with similar effects for RT-expressive writing and RT-verbal disclosure. Evidence for the use of RT skills was found in journals and recordings. The findings provide support for RT intervention fidelity and support moving forward to test RT effectiveness in reducing grandmothers' stress and promoting their mental health.
Collapse
|
12
|
Zauszniewski JA, Musil CM, Burant CJ, Au TY. Resourcefulness training for grandmothers: preliminary evidence of effectiveness. Res Nurs Health 2013; 37:42-52. [PMID: 24277351 DOI: 10.1002/nur.21574] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2013] [Indexed: 11/08/2022]
Abstract
In this pilot study of 102 grandmothers raising grandchildren, we used a quasi-experimental, repeated measures design to examine effects of resourcefulness training reinforced by expressive writing (journaling) or verbal disclosure (digital voice recording) in reducing stress and depressive symptoms and enhancing quality of life. Resourcefulness training was compared with expressive writing, verbal disclosure, and attention control conditions. Both the expressive writing and verbal disclosure methods for reinforcing resourcefulness training were more effective than the other three conditions in reducing stress and depressive symptoms and improving quality of life. No difference was found between the two reinforcement methods. Grandmothers may benefit from learning resourcefulness skills and from practicing them in ways that best fit their needs and lifestyles.
Collapse
Affiliation(s)
- Jaclene A Zauszniewski
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4904
| | | | | | | |
Collapse
|
13
|
Musil CM, Jeanblanc AB, Burant CJ, Zauszniewski JA, Warner CB. Longitudinal analysis of resourcefulness, family strain, and depressive symptoms in grandmother caregivers. Nurs Outlook 2013; 61:225-234.e2. [PMID: 23756496 PMCID: PMC3786552 DOI: 10.1016/j.outlook.2013.04.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/20/2013] [Accepted: 04/28/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Grandmothers living with grandchildren face stressors that may increase depressive symptoms, but cognitive-behavioral strategies, such as resourcefulness, may reduce the effects of stressors on mental health. PURPOSE This analysis examined the contemporaneous and longitudinal relationships among intra-family strain, resourcefulness, and depressive symptoms in 240 grandmothers, classified by caregiving status to grandchildren. METHODS Grandmothers raising grandchildren, grandmothers living in multigenerational homes, and non-caregivers to grandchildren reported on intra-family strain, resourcefulness, and depressive symptoms using mailed questionnaires at three time points over 5 years. Structural equation modeling was used to evaluate the mediating effects of resourcefulness and the relationships between variables. DISCUSSION Grandmother caregiver status had significant effects on depressive symptoms and intra-family strain but not on resourcefulness. At all waves, higher resourcefulness was associated with fewer depressive symptoms, which reduced appraisals of intra-family strain. CONCLUSIONS Interventions focused on strengthening resourcefulness could reduce depressive symptoms over time.
Collapse
Affiliation(s)
- Carol M Musil
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA.
| | | | | | | | | |
Collapse
|