Browsing by Author "McLennon, Susan M."
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Item Activities and support provided by family caregivers of persons with type 2 diabetes(2016-03-11) Scarton, Lisa J.; Bakas, Tamilyn; Miller, Wendy; McLennon, Susan M.; Huber, LesaType 2 diabetes, a chronic condition affecting millions, continues to rise in epidemic proportions. Type 2 diabetes, managed through lifestyle changes, affects the entire family. Family caregivers provide vital support to these individuals; however, little research has been conducted surrounding the perceived difficulty or ease of caregiver activity and supportive behaviors. The purpose of this dissertation was to develop and psychometrically test a scale that measures this difficulty or ease of activities and behaviors. This was accomplished through the compilation of three distinct manuscripts. First, an integrative review was conducted to identify what is known regarding needs and concerns of family caregivers of persons with type 2 diabetes; findings revealed a need for more research. Then, based on these recommendations, a qualitative study was conducted that explored the needs and concerns identified by 33 American Indian, African American, and White family caregivers. All these caregivers had similar concerns related to needing general diabetes information, providing support to the family member, and taking care of their own health. Study themes were used to develop items for a new instrument, the Diabetes Caregiver Activity and Support Scale (D-CASS) that was psychometrically tested with 101 American Indian, African American, and White family caregivers of persons with type 2 diabetes. This study used a cross-sectional, descriptive-correlational design and provided evidence of internal consistency reliability (α = .82) and two-week test-retest reliability (intraclass correlation coefficient = .70) for the D-CASS. Criterion-related validity was established using a single-item criterion measuring overall how easy or difficult it was for caregivers to provide care for their loved ones (r = .65, p < .01). Unidimensionality was supported by factor analysis, with loadings ranging from .45 to .70, with 32% of the variance explained by the first factor (eigenvalue = 4.02). Model testing through a series of three hierarchical multiple regressions guided by a conceptual model provided further evidence of construct validity for the D-CASS. This dissertation provided better understanding of needs and concerns of family caregivers of persons with type 2 diabetes and led to the development of a psychometrically sound diabetes-specific instrument for future research.Item Are there gender, racial or relationship differences in caregiver task difficulty, depressive symptoms and life changes among stroke family caregivers?(Taylor & Francis, 2015) Jessup, Nenette M.; Bakas, Tamilyn; McLennon, Susan M.; Weaver, Michael T.; IU School of NursingOBJECTIVE: To examine differences in caregiver perceptions of task difficulty, depressive symptoms and life changes based on caregiver characteristics of gender, race and type of relationship to the person with stroke. METHODS: A sample of 243 stroke caregivers (females n = 191; males n = 52; non-African Americans n = 184; African Americans n = 59; non-spouses n = 127; spouses n = 116) were interviewed by telephone within 8 weeks of the survivor's discharge to home. Measures included the Oberst Caregiving Burden Scale (OCBS) for task difficulty, Patient Health Questionnaire (PHQ-9) for depressive symptoms and Bakas Caregiving Outcomes Scale (BCOS) for life changes. Three general linear models computed differences in OCBS, PHQ9 and OCBS scores. RESULTS: Significant differences were found on the OCBS for females (p < 0.001) and African American spouses (p < 0.048); on the PHQ9 for females (p < 0.001), non-African Americans (p = 0.047), spouses (p = 0.003) and African-American spouses (p = 0.010); and on the BCOS for females (p = 0.008) and non-African Americans (p = 0.033). CONCLUSIONS: Findings suggest that female and non-African American stroke caregivers are relatively more likely to experience task difficulty, depressive symptoms and negative life changes as a result of providing care. African American spouses were also at risk. Tailoring interventions based on caregivers' characteristics may improve outcomes.Item Comparing treatment fidelity between study arms of a randomized controlled clinical trial for stroke family caregivers(Sage, 2016-05) McLennon, Susan M.; Hancock, Rebecca D.; Redelman, Kathleen; Scarton, Lisa L.; Riley, Elizabeth; Sweeney, Bobbie; Habermann, Barbara; Jessup, Nenette M.; Bakas, Tamilyn; School of NursingOBJECTIVE: To compare treatment fidelity among treatment arms in the Telephone Assessment and Skill-Building Kit study for stroke caregivers (TASK II) with respect to: 1) protocol adherence; 2) intervention dosage and 3) nurse intervener perspectives. DESIGN: A randomized controlled clinical trial design. SETTING: Urban, community, midwestern United States. SUBJECTS: A total of 254 stroke caregivers (mean ±SD age, 54.4 ±11.8 years), 55 (22.0%) males and 199 (78.4%) females) randomized to the TASK II intervention (n=123) or an Information, Support, and Referral comparison group (n=131). INTERVENTIONS: TASK II participants received the TASK II Resource Guide; Information, Support, and Referral participants received a standard caregiver brochure. At approximately 8 weeks after discharge, both groups received 8 weekly calls from a nurse, with a booster call 4 weeks later. MEASURES: Protocol adherence was evaluated with the TASK II Checklist for Monitoring Adherence. Intervention dosage was measured by the number of minutes caregivers spent reading materials and talking with the nurse. Nurse intervener perspectives were obtained through focus groups. RESULTS: Protocol adherence was 80% for the TASK II and 92% for the Information, Support, and Referral. As expected, intervention dosage differed between TASK II and Information, Support, and Referral with respect to caregiver time spent reading materials (t=-6.49; P<.001) and talking with the nurse (t=-7.38; P<.001). Focus groups with nurses yielded further evidence for treatment fidelity and recommendations for future trials. CONCLUSIONS: These findings substantiate treatment fidelity in both study arms of the TASK II stroke caregiver intervention trial (NIH R01NR010388; ClinicalTrials.govNCT01275495).Item The Indiana University School of Nursing Clinical Faculty Mentoring Initiative(Office of Academic Affairs, IUPUI, 2015-02-01) Cullen, Deborah L.; McLennon, Susan M.; Shieh, CarolItem Nursing Professional Capital: A Qualitative Analysis(Wolters, 2015-02) Lasiter, Sue; McLennon, Susan M.; School of NursingOBJECTIVE: The objective of this study was to offer qualitative support for the assertion that nurses possess professional capital. BACKGROUND: Nurses embrace professional standards and tenets that have been measured as trust and ethics. By understanding forms of capital and combining quantitative public-opinion surveys and our qualitative findings, a case can be made that nurses possess professional capital. METHOD: This was a focused review of existing interview data and was conducted using inductive content analysis. FINDINGS: Patients provided unsolicited accounts of trust and positive regard for their nurses. CONCLUSION: Evidence supports that in combination with trust and positive regard, nurses possess professional capital. Nurses should judiciously use their professional capital to impact institutional, political, and economic policy.Item Oncology Nurses’ Experiences with Prognosis Related Communication(Office of the Vice Chancellor for Research, 2013-04-05) McLennon, Susan M.; Lasiter, Sue; Miller, Wendy; Amlin, Kathryn; Chamness, Amy R.; Helft, Paul R.Background: Oncology nurses have opportunities to engage in prognosis related communication with advanced cancer patients but often encounter barriers that impede patient prognosis understanding. Deficits in prognosis understanding have been associated with delays in transitions to end of life care, overly aggressive and potentially non-beneficial cancer treatments, and poor quality of life. Purpose: The purpose of this study was to describe nurses' experiences with prognosis related communication with advanced cancer patients. Methods: A framework of realism was used in this qualitative, descriptive design. A thematic analysis of audio-recorded interviews with oncology nurses (n=27) recruited from a Midwestern urban academic health center and 3 affiliated institutions was performed. Interviews were transcribed verbatim and accuracy checked. Data were coded by 3 experienced researchers. After coding, themes were identified, and a thematic map was developed. Methods to ensure trustworthiness of the findings were used. Results: Six themes were identified: Being in the middle, assessing the situation, barriers to prognosis communication, nurse actions, benefits of prognosis understanding, and negative outcomes. Nurses managed barriers through facilitation, collaboration, or independent actions to assist patients and/or families with prognosis understanding. Conclusions: Shortcomings in prognosis related communication with advanced cancer patients may contribute to negative outcomes for patients and nurses. Interventions to advance nurses’ abilities to facilitate and engage in prognosis communications are needed. Inter-professional communication skills education may also be beneficial.Item Preliminary Efficacy of a Stroke Caregiver Intervention Program for Reducing Depressive Symptoms(Office of the Vice Chancellor for Research, 2013-04-05) Bakas, Tamilyn; Austin, Joan K.; Buelow, Janice M.; Habermann, Barbara; Li, Yong; McLennon, Susan M.; Weaver, Michael T.; Williams, Linda S.Background and Purpose: Stroke caregivers who lack skills because of unmet needs are at increased risk for depressive symptoms; which can impede rehabilitation of the survivor and increase the survivor’s risk for costly, long-term institutionalization. The Telephone Assessment and Skill-Building Kit (TASK) is an 8-week follow-up program based on individualized assessment of caregiver needs. The purpose of this study was to explore preliminary efficacy of the TASK program for improving stroke caregiver depressive symptoms. Methods: A subgroup of 15 caregivers who screened positive for mild to severe depressive symptoms at baseline (PHQ-9 > 5) were randomized to the TASK program (n=8) or an attention control group (n=7). Data were analyzed using Univariate ANCOVA, controlling for baseline scores and number of minutes spent with the nurse for each timepoint (4, 8, and 12 weeks after baseline). Partial ƞ2 was used to estimate effect sizes (< .08 small, .09-.24 medium, >.25 large). Results: Although not statistically significant because of the small sample size, medium to large improvements based on effect sizes were found in depressive symptoms for the TASK group relative to the control group at 4 weeks [F(1,11) = 4.15, p=.07, ƞ2=.27], 8 weeks [F(1,11) = 1.66, p=.22, ƞ2=.13], and 12 weeks after baseline [F(1,11) = 1.47, p=.25, ƞ2 =.12]. Adjusted PHQ-9 means for the TASK group at 4, 8, and 12 weeks ranged from 4.9 to 5.9; adjusted PHQ-9 means for the control group at 4, 8, and 12 weeks ranged from 9.0 to 10.8. Conclusions: Caregivers in the TASK group reduced their depressive symptoms to the mild range, while caregivers in the control group maintained their scores primarily in the moderately depressed range. Further testing of the TASK program in a larger randomized controlled clinical trial is warranted and is currently underway.Item SYMPTOM CORRELATES OF CAREGIVER BURDEN IN SPOUSES OF PERSONS WITH DEMENTIA(Office of the Vice Chancellor for Research, 2012-04-13) Malan, Jamee S.; McLennon, Susan M.Caregiver burden is a key predictor of institutionalization of persons with dementia. Using the Lenz et al. (1997), Theory of Unpleasant Symptoms as a guide, the purpose of this study was to determine whether pain, fatigue, or depressive symptoms are associated with caregiver burden among spouses of persons with dementia. A secondary analysis of an existing database of a cross-sectional, descriptive study of 83 spouses of persons with dementia was conducted. Spouses were predominately female (60%) and Caucasian (76%) with a mean age of 77 years. Symptom data were collected using items from the SF-36v2. Burden data was collected using the abridged Zarit Burden Interview. Data were analyzed using descriptive, correlational, and multiple regression statistical analyses. Spouse caregiver pain, fatigue, and depressive symptoms were significantly associated with caregiver burdenItem Systematic review of health-related quality of life models(BioMed Central, 2012-11-16) Bakas, Tamilyn; McLennon, Susan M.; Carpenter, Janet S.; Buelow, Janice M.; Otte, Julie L.; Hanna, Kathleen M.; Ellett, Marsha L.; Hadler, Kimberly A.; Welch, Janet L.; School of NursingA systematic literature review was conducted to (a) identify the most frequently used health-related quality of life (HRQOL) models and (b) critique those models.Item Task difficulty and life changes among stroke family caregivers: relationship to depressive symptoms(Elsevier, 2014-12) McLennon, Susan M.; Bakas, Tamilyn; Jessup, Nenette M.; Habermann, Barbara; Weaver, Michael T.; School of NursingOBJECTIVES: To investigate differences in stroke caregiver task difficulty and life changes based on level of caregiver depressive symptoms, and to estimate probabilities among task difficulty and life change items. DESIGN: Descriptive analysis of baseline data from an ongoing stroke caregiver intervention trial. SETTING: Hospitals and rehabilitation facilities. PARTICIPANTS: Caregivers (N=242; 78.6% women; 47.7% spouses; 71.8% white; mean age, 54.2±12.1y) caring for stroke survivors within 8 weeks of discharge to home. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Baseline measures for task difficulty (Oberst Caregiving Burden Scale) and life changes (Bakas Caregiving Outcomes Scale) were compared based on level of depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores <5 means no depressive symptoms; n=126; PHQ-9 scores ≥5 means mild to severe depressive symptoms, n=116). Mean scores were analyzed using general linear modeling, with item analyses using logistic regression and the Benjamini-Hochberg method to control type I error inflation. RESULTS: Caregivers with mild to severe depressive symptoms have greater difficulty with tasks and worse life changes than those with no depressive symptoms (P<.001). Odds ratios were highest for the task of arranging care while away and for negative life changes (eg, addressing self-esteem, coping with stress, physical health). CONCLUSIONS: Findings underscore the importance of depressive symptom screening for stroke caregivers during or shortly after discharge. Assisting caregivers with depressive symptoms to arrange for respite care and addressing negative physical and psychological changes may be priority areas for future interventions.