Childhood Maltreatment and Spiritual Well-Being: Intolerance of Uncertainty and Emotion Regulation as Mediators in Turkish Sample

Spiritual well-being is a phenomenon that enhances the quality of life and acts as a protective factor against stress and negative emotions. The purpose of this study was to investigate whether childhood psychological maltreatment is related to spiritual well-being and whether intolerance of uncertainty and emotion regulation serially mediate this relationship. The study sample comprised 330 participants aged between 18 and 55 years from 46 out of the 81 cities in Türkiye. The study participants completed the Psychological Maltreatment Questionnaire, Intolerance of Uncertainty Scale, Emotion Regulation Scale, and Spiritual Well-Being Scale, a scale derived from the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being that measures spiritual well-being by using the conceptualization of meaning and peace. The data obtained were analyzed using a two-step structural equation modeling approach, which indicated that childhood psychological maltreatment has an association with spiritual well-being, and this relationship is mediated by both intolerance of uncertainty and emotion regulation. The findings are discussed in the context of the literature on spiritual well-being.

Spirituality in Patients With Heart Failure

With advances in heart failure (HF) treatment, patients are living longer, putting further emphasis on quality of life (QOL) and the role of palliative care principles in their care. Spirituality is a core domain of palliative care, best defined as a dynamic, multidimensional aspect of oneself for which 1 dimension is that of finding meaning and purpose. There are substantial data describing the role of spirituality in patients with cancer but a relative paucity of studies in HF. In this review article, we explore the current knowledge of spirituality in patients with HF; describe associations among spirituality, QOL, and HF outcomes; and propose clinical applications and future directions regarding spiritual care in this population. Studies suggest that spirituality serves as a potential target for palliative care interventions to improve QOL, caregiver support, and patient outcomes including rehospitalization and mortality. We suggest the development of a spirituality-screening tool, similar to the Patient Health Questionnaire-2 used to screen for depression, to identify patients with HF at risk for spiritual distress. Novel tools are soon to be validated by members of our group. Given spirituality in HF remains less well studied compared with other patient populations, further controlled trials and uniform measures of spirituality are needed to understand its impact better.

Kellner's Symptom Questionnaire, a Highly Sensitive Patient-Reported Outcome Measure: Systematic Review of Clinimetric Properties

INTRODUCTION

Patient-reported outcomes (PROs) are of increasing importance in clinical medicine. However, their evaluation by classic psychometric methods carries considerable limitations. The clinimetric approach provides a viable framework for their assessment.

OBJECTIVE

The aim of this paper was to provide a systematic review of clinimetric properties of the Symptom Questionnaire (SQ), a simple, self-rated instrument for the assessment of psychological symptoms (depression, anxiety, hostility, and somatization) and well-being (contentment, relaxation, friendliness, and physical well-being).

METHODS

The PRISMA guidelines were used. Electronic databases were searched from inception up to March 2019. Only original research articles, published in English, reporting data about the clinimetric properties of the SQ, were included.

RESULTS

A total of 284 studies was selected. The SQ has been used in populations of adults, adolescents, and older individuals. The scale significantly discriminated between subgroups of subjects in both clinical and nonclinical settings, and differentiated medical and psychiatric patients from healthy controls. In longitudinal studies and in controlled pharmacological and psychotherapy trials, it was highly sensitive to symptoms and well-being changes and discriminated between the effects of psychotropic drugs and placebo.

CONCLUSIONS

The SQ is a highly sensitive clinimetric index. It may yield clinical information that similar scales would fail to provide and has a unique position among the PROs that are available. Its use in clinical trials is strongly recommended.

Predictors of Depressive Symptoms in Heart Failure Caregivers

Heart failure is a serious and complex chronic illness and family caregivers often assist these individuals in performing self-care. Unsurprisingly, caregivers often are overwhelmed by daily activities associated with heart failure management and frequently have depressive symptoms. This study examined predictors (i.e., sociodemographic and clinical characteristics, social support, social problem-solving, family functioning, and objective and subjective burden) of depressive symptoms in 530 informal caregivers of individuals with heart failure in a large cross-sectional, descriptive study in the community. Younger caregivers who provided care for longer periods of time, lived in rural areas, and had less social support and lower problem-solving skills were more likely to have depressive symptoms. These findings emphasize the need for further studies to develop dynamic and innovative approaches that incorporate multiple components to lessen caregiving challenges. Social support and problem-solving skills training may be useful components to lessen depressive symptoms in these younger, rural caregivers.

Spiritual Well-Being in Cancer Patients Undergoing Chemotherapy in an Outpatient Setting: A Cross-Sectional Study

Purpose: To assess the spiritual well-being (SWB) of cancer patients undergoing chemotherapy in an outpatient setting. Method: Quantitative, cross-sectional, and descriptive study. A convenience sample of 150 participants was obtained. Data collection instrument was a self-reported questionnaire that included the SWB Questionnaire (SWBQ), whose scores range from 20 to 100. SPSS software, version 21, was used in data analysis. The study was approved by the institutional ethics committee. Results: Patients’ ages ranged between 35 and 83 years; most were female (64.7%), married (68.0%), Catholic (86.7%), and with breast cancer (35.3%) and colorectal cancer (25.3%). The average SWBQ total score was 65.91 ( SD = 12.177). The highest score of the SWBQ was obtained in females, widows and singles, Evangelic and Catholic, and with lower educational level and professional occupation. The Cronbach α was 0.89, and the subscales αs ranged between 0.78 and 0.94. Conclusion: The SWBQ scores were reasonable. These results can guide nurses’ clinical reasoning, as the assessment of SWB may precede the diagnosis of risk for spiritual distress, readiness for enhanced SWB, or spiritual distress. Thus, the use of this instrument may facilitate spirituality being effectively implemented in clinical practice, favoring holistic health care.

Mediating effect of spiritual coping strategies and family stigma stress on caregiving burden and mental health in caregivers of persons with dementia

Background A considerable number of the persons living with dementia rely on family members for care and assistance when performing activities of daily living. As a result, caregivers may be at increased risk for mental health problems such as depression, anxiety and caregiver burden. This study examined if and how spiritual coping and stigma-related family stress impacted the associations between the patient activities of daily living impairment and caregiver mental health. Methods Using a longitudinal design, 664 caregivers were assessed at baseline for spiritual coping strategies and family stigma stress, along with patients' instrumental activities of daily living and cognitive functioning. After 12 months, caregivers were assessed for depressive and anxiety symptoms, caregiver burden, and quality of life (physical and mental). Sequential mediation of spiritual coping strategies and stigma-related family stress on the relationship between patient instrumental activities of daily living and caregiver mental health outcomes was examined using the PROCESS macro statistical method. Results Participants had been caring for someone with dementia for an average of 46.4 (SD, 16.9) months and 63% of caregivers were female. There were significant indirect associations between patient instrumental activities of daily living and caregiver anxiety, depression, caregiving burden, and the mental health component of quality of life. Spiritual coping and stigma-related stress mediated these associations (-0.54 Collapse

Key Words

• caregiver
• coping
• dementia
• elderly
• mental health
• spiritual

Collapse

MESH Headings Collapse

Grants Collapse

Affiliation(s)

Mohsen Saffari Baqiyatallah University of Medical Sciences, Iran
Harold G Koenig Duke University Medical Center, USA; King Abdulaziz University, Saudi Arabia; Ningxia Medical University, China
Keisha N O'Garo Duke University Medical Center, USA
Amir H Pakpour Qazvin University of Medical Sciences, Iran; Jönköping University, Sweden

Collapse

The relationship between family functioning and caregiving appraisal of dementia family caregivers: caregiving self-efficacy as a mediator

OBJECTIVES

The aim of this study was to explore caregiving self-efficacy as a mediator for the association between family functioning and caregiving appraisal of dementia family caregivers in Taiwan.

METHOD

This study adopted a cross-sectional correlational design. Purposive sampling was used to recruit 115 dyads of dementia patients and family caregivers from the outpatient neurological clinics of two hospitals in northern Taiwan. Data were gathered through interviews with a structured questionnaire, which included demographic characteristics for caregivers and patients, family functioning, caregiving self-efficacy, as well as positive and negative aspects of caregiving appraisal.

RESULTS

Family functioning, patients' activities of daily living score, Neuropsychiatric Inventory caregiver distress, and three domains of self-efficacy were significantly associated with caregiver burden. Hierarchical multiple regression analyses indicated that self-efficacy for obtaining respite (SE-OR) significantly explained 20.5% of the variance in caregiver esteem. Caregiver perceived worsened health status, family functioning, and SE-OR significantly explained 59% of the variance in caregiver burden. The mediation test only supported the partially mediating role of SE-OR on the relationship between family functioning and caregiver burden, while the mediating effect of self-efficacy for responding to disruptive behaviours and controlling upsetting thoughts were insignificant.

CONCLUSION

Our findings provided preliminary evidence for health professionals recommending that future studies should assess the family dynamic and health problems of caregivers, and develop appropriate family-centred interventions that focus on strengthening interfamily support and respite services to alleviate caregiver burden.

Influence of Religion on Later Burden and Health of New Black and White Caregivers

Objective: We assessed the relationship between positive aspects of religiosity and reduced stress in caregivers, and negative aspects of religiosity and increased caregiver burden. Method: Using data from the Biopsychosocial Religion and Health Study, we performed multiple linear regression analysis on 584 caregivers. Results: Mental health, but not physical health, was predicted by caregiver burden. Caregivers who viewed God as loving and not controlling and felt a sense of community with their church family had less burden. Caregivers who engaged in negative religious coping had a greater decline in mental health than those who saw God as loving and not controlling and who gave emotional support to others. Discussion: Some aspects of religion appear to play an important role in alleviating the mental stresses of being a caregiver.

CONTENT VALIDATION OF NURSING OUTCOMES IN RELATION TO FAMILY CAREGIVERS: CONTENT VALIDATION BY BRAZILIAN AND COLOMBIAN EXPERTS

ABSTRACT Objective: this study's aim was to estimate the content validity of nursing outcomes in relation to family caregivers. Method: eleven Brazilian and Colombian experts participated in the study. None of the 61 indicators of the four nursing outcomes were considered irrelevant; 42 (68.9%) were considered primary and 19 (31.1%) were considered secondary. Results: the indicators with higher validity scores were: family share care responsibilities for Caregiver well-being (CVI=0.85); disruption of family dynamics to Caregiver lifestyle disruption (CVI=0.85); perceived spiritual well-being and anger for Caregiver emotional health (CVI=0.79) and perceived general health to Caregiver physical health (CVI=0.79). Conclusion: the nursing outcomes studied had adequate content validity. It is recommended that content validation followed by clinical and construct validation of the nursing-sensitive outcomes be given in different cultures and care settings.

Measuring the impact of informal elderly caregiving: a systematic review of tools

PURPOSE

To classify and identify the main characteristics of the tools used in practice to assess the impact of elderly caregiving on the informal carers' life.

METHODS

A systematic review of literature was performed searching in Embase, MEDLINE, PsycINFO, CINAHL, IBECS, LILACS, SiiS, SSCI and Cochrane Library from 2009 to 2013 in English, Spanish, Portuguese and French, and in reference lists of included papers.

RESULTS

The review included 79 studies, among them several in languages other than English. Their inclusion increased the variety of identified tools to measure this impact (n = 93) and allowed a wider analysis of their geographical use. While confirming their overlapping nature, instruments were classified according to the degree of integration of dimensions they evaluated and their specificity to the caregiving process: caregiver burden (n = 20), quality of life and well-being (n = 11), management and coping (n = 21), emotional and mental health (n = 29), psychosocial impact (n = 10), physical health and healthy habits (n = 2), and other measures. A high use in practice of tools not validated yet and not caregiver-specific was identified.

CONCLUSIONS

The great variety and characteristics of instruments identified in this review confirm the complexity and multidimensionality of the effects of elderly caregiving on the informal carer's life and explain the difficulties to assess these effects in practice. According to the classification provided, caregiver burden and emotional and mental health are the most evaluated dimensions. However, further work is required to develop integrated and caregiving focused procedures that can appraise this complexity across different countries and cultures.

Use of Zarit Burden Interview in analysis of family caregivers' perception among Taiwanese caring with hospitalized relatives

This study was conducted to examine the relationships between family caregivers' perception of caregiving and its influencing factors among Taiwanese with hospitalized relatives. The study used a cross-sectional and descriptive correlational design. A convenience sample of 200 primary caregivers of hospitalized patients diagnosed with cancer, stroke and chronic illness was recruited in a Taiwanese Medical Center; this focus was chosen because cancer, stroke and chronic illness generally require long term care. Data were collected by structured questionnaires. Pearson product-moment correlation and stepwise multiple regression analyses were used to analyse the results of this study. Family caregivers who lacked family support and whose patients' ADL (activities of daily living) dependency was increasing experienced a greater caregiving burden. Family caregivers who had better psychological well-being, better quality of relationship and more caregiving knowledge experienced a lower caregiving burden. Quality of relationship, lack of family support and patients' ADL dependency accounted for 43% of the Zarit Burden Interview variance. The results indicated that family caregivers' perception of caregiving included sacrifice, strain, embarrassment, anger and loss of control. It is vital for nurses to understand these caregiving perceptions and their related factors to provide a holistic care plan.

Influences of Psychological Well-being, Quality of Caregiver-patient Relationship, and Family Support on the Health of Family Caregivers for Cancer Patients in Taiwan

PURPOSE

The purpose of this study was to examine the influences of psychological well-being, quality of caregiver-patient relationship, and family support on the health of family caregivers for cancer patients in a Taiwanese hospital.

METHODS

A cross-sectional, correlational design was used. A sample of 91 family caregivers of hospitalized cancer patients completed the Caregiver Reaction Assessment and Psychological Well-Being Scale. Pearson's product moment correlation and regression analyses were used to examine the data.

RESULTS

The psychological well-being and the quality of the caregiver-patient relationship of family caregivers were found to be significantly positively correlated with caregivers' health. The lack of family support was found to be significantly negatively correlated with caregivers' health. Psychological well-being, quality of caregiver-patient relationship, and family support accounted for 59% of the variance in caregivers' health.

CONCLUSION

The findings suggest that nurses, while providing care in the hospital and upon discharge need to be aware of the psychological well-being, quality of caregiver-patient relationship, and family support of a family caregiver, as these factors all have an impact on a family caregiver' health.

Strategies for Sustaining Self Used by Family Caregivers for Older Adults With Dementia

The negative health consequences of caring for an older adult family member with dementia are well documented. However, not all family caregivers experience these negative health consequences. The purposes of this study were to describe strategies family caregivers use to help them continue to provide care for an older family member with dementia despite challenges and describe these family caregivers’ resilience and psychological distress. A mixed methods design was used with a narrative approach dominant and standardized scales for resilience and psychological distress used to enhance the description of the sample. Data were collected through telephone interviews with 18 family caregivers residing in an urban area. The findings indicate that family caregivers used four strategies to sustain the self: drawing on past life experiences, nourishing the self, relying on spirituality, and seeking information about dementia. Understanding strategies used by family caregivers to sustain themselves is essential for providing holistic nursing care and developing effective interventions.

Psychological distress and mental health of Thai caregivers

BACKGROUND: As the proportion of elderly people within a population increases there is an accompanying increase in the role of informal caregivers. Many studies on caregivers report negative health outcomes but very few have addressed positive aspects of caregiving. This study examines characteristics of Thai caregivers, the distribution of psychological distress and mental health among caregivers, and the association between caregiver status and psychological distress. METHODS: This report is based on an ongoing national cohort study of 60,569 Thai adults. Caregiving was common in the cohort, and in 2009 6.6% were full-time and 27.5% were part-time caregivers. Outcomes of the study were reported using an international standard Kessler 6 for psychological distress and a national Thai Mental Health Indicator. Determinants included age, sex, marital status, household income, work status and urban-rural residence. Frequency of social contacts was also included as explanatory variable. RESULTS: Among cohort members, 27.5% were part-time caregivers and 6.6% were full-time caregivers. Compared to non-caregivers, full-time caregivers tended to be older, to be married, more likely to be in the lowest household income group, to be unpaid family members, and to reside in rural areas. We noted the seeming contradiction that when compared to non-caregivers, the caregivers reported higher psychological distress but higher positive mental health (i.e., self-esteem and content with life), higher positive mental capacity (i.e., coping with crises), and higher positive mental quality (i.e., helping others). After adjusting for possible covariates, part-time and full-time caregivers were more likely to report high psychological distress (Adjusted Odds Ratios, AOR 1.33 and 1.78 among males and 1.32 and 1.45 among females). Less contact with colleagues was associated with high psychological distress both in males and females (AOR 1.36 and 1.33). Less contact with friends was also associated with high psychological distress, especially among females (AOR 1.27 and 1.42). CONCLUSIONS: This study highlights caregivers in Thailand, the strong possibility of mental health benefits, some risks of associated psychological distress, and the positive role of keeping social contacts. Early identification of vulnerable caregivers is required to target effective health promotion.

Family carer reactions and their related factors among Taiwanese with hospitalized relatives

AIM

The purpose of this study was to examine the relationships among family carer reactions and their related factors among Taiwanese with hospitalized relatives.

BACKGROUND

In Taiwan, most hospitalized patients have relatives or foreign labourers with them 24 hours a day. Limited research has focused on the reactions of family members who provide care for hospitalized relatives.

METHODS

A cross-sectional, correlation design was used. A convenience sample of 200 primary carers of hospitalized patients diagnosed with cancer, stroke, and enduring illness was recruited between 2009 and 2010. Data were collected by structured questionnaires.

RESULTS

The findings indicate that participants with a moderate level of family support experienced a moderate impact on health and finances, but a high impact on schedule. Family carers' health status and work time were significantly different between, before and after serving as a carer. The multiple regression model variables accounted for 40.1% of the total family carer reaction variance. Three factors were found to predict significantly greater impact on a family carer: (1) lower scores of caregiving knowledge, (2) increasing patient's activities of daily living dependency and (3) lack of family support.

CONCLUSION

It is vital for nurses not only to assess patients' activities of daily living, but also to assess family carers' knowledge of caregiving and the patient's existing family support in developing a plan of care that reduces negative impact on family carers.

Delirium in older adults attending adult day care and family caregiver distress

BACKGROUND; Delirium is a critical, costly, frequently reversible problem in older adults. Findings of previous studies indicate that delirium occurs in up to 65% of hospitalised older adults and up to 80% of terminally ill patients. Few studies address the frequency of delirium in community dwelling older adults and the extent to which delirium symptoms create distress for their family caregivers.

AIMS

To determine the frequency of delirium in older people attending two adult day centers (ADC) in the United States and identify the extent to which delirium symptoms were associated with family caregivers' mental health symptoms, and ways of coping with the older adults' care.

METHOD

A descriptive, cross-sectional design was used. Thirty older adults and their family caregivers were randomly selected from the rosters of the ADC.

RESULTS

Only 6.7% of the older adults had a positive screen for delirium. The majority of family caregivers (96.6%) stated that they had no knowledge of delirium prior to participating in this study.

IMPLICATIONS FOR PRACTICE

Both older adults and their family caregivers need education about delirium symptoms and risks.