The HOME scale: the influence of socioeconomic status on the evaluation of the home environment.

Caldwell's Home Observation for Measurement of the Environment (HOME) was developed to provide specific and sensitive information about the home and maternal environment as a stimulus to infant learning and development. The use of the HOME scale was examined in a sample of 118 middle- and lower-income mothers and their low-birth-weight (LBW) or very-low-birth-weight (VLBW) infants. The analysis of data demonstrated limited variability in the HOME scale total scores within each income group, and income alone was found to account for 41% of the variance in the sample. These findings raise questions about the effectiveness of the HOME scale in making useful discriminations about family functioning within an income group.     

Culture Sensitivity in Assessing Urban Native American Parenting

Abstract Assessing urban Native American (NA) parenting remains a challenge for public health nurses. This study explored the effectiveness of using the NCATS and HOME instruments with urban NA mothers and their children. Scores for 63 sets of mothers and their children age 3 months to 3 years on the home observation for measurement of the environment (HOME) and nursing child assessment teaching scale (NCATS) instruments were compared with norms for those instruments. Scores were lower than the norms on the play and involvement subscales of the HOME, and higher than the norms on the total parent, clarity of cues, response to parent, and total child subscales of the NCATS. Analysis of responses to specific items indicated that these mothers were unlikely to structure and intervene in children's activities and likely to use nonverbal parenting techniques. Findings supported the usefulness of these instruments with NA parents when accompanied by discussion of findings with them, and nurse awareness of common family structures and traditional values.     

Maternal sensitivity and attachment security in Thailand: cross-cultural validation of Western measures

The purpose of this study was to examine the psychometric properties of Thai versions of the Maternal Behavior Q-Sort (MBQS), Caldwell's HOME, and the Attachment Q-set (AQS). A sample of 110 Thai mother-infant dyads were studied. The Content Validity Index (CVIs) of the Thai MBQS, HOME and AQS were between 91% and 99%. Internal consistency of the HOME was .71. Interobserver reliability of the MBQS, HOME, and AQS were .95, .87, and .87, respectively. Convergent validity was supported by finding a positive correlation between the MBQS and the HOME (r = .29, p < .001). A positive correlation of .45 (p < .001) between the scores of the MBQS and the AQS indicated concurrent validity of these scales. Study findings indicate the Thai MBQS, HOME, and AQS are reliable and valid in this Thai sample and suggest that the Thai versions reflect concepts similar to those in the original English versions.     

Differences in health-related quality of life between older nursing home residents without cognitive impairment and the general population of Norway

Aim. To advance the understanding of health-related quality of life among older nursing home residents by assessing their health-related quality of life and comparing this with norms from the general population. Methods. The study used a two-group cross-sectional comparative design. The samples comprised 227 nursing home residents aged 65–102 years with at least six months’ residence and a representative population sample of 1137 Norwegian citizens aged 65–102 years. All nursing home residents had a Clinical Dementia Rating Scale score ≥0·5 and were capable of conversing. The respondents provided demographic information and were surveyed using the SF-36 Health Survey. We used univariate and multivariate linear models to identify possible differences in health-related quality of life between the nursing home residents and the general population, controlled for age, sex, marital status and education. Results. After adjustment for age, group, sex, marital status and education, the nursing home residents scored significantly higher on bodily pain and on physical and emotional role limitation and significantly lower on the other SF-36 subscales, except social functioning, with the largest differences for physical functioning (mean nursing home 23·2 and mean general population 62·9). The general population scores on all subscales generally increased with increasing education but not among the nursing home residents. Conclusions. The mean SF-36 scale scores differed markedly between the nursing home residents and the general population, with the nursing home residents generally scoring lower. The association with background variables known to be related to health-related quality of life differed between the groups. Healthcare professionals should increase attention to health-related quality of life among nursing home residents, periodically assess health-related quality of life and consider interventions that may improve health-related quality of life in older institutionalised populations. Relevance to clinical practice. This study highlights the role of nurses and other health professionals in ensuring that nursing home residents have opportunities to improve their health-related quality of life.     

Psychometric properties of a Chinese version of the home environment measure for motor development

Purpose.?This study examined the psychometric properties of the Chinese version of the Affordance in the Home Environment for Motor Development – Toddler version (AHEMD-Toddler-C) for children developing typically (DT) or having motor delays (MD).

Methods.?This was a methodology study. Parent–child dyads with DT (n == 106, mean age of 27.9 months) and with MD (n == 45, 23.6 months) were enrolled. For test-retest reliability, parents completed AHEMD-Toddler-C twice within 2 weeks. For convergent validity, correlations were analysed between AHEMD-Toddler-C and Home Observation for Measurement of the Environment Inventory (HOME), and between AHEMD-Toddler-C and family variables.

Results.?Test-retest reliabilities for AHEMD-Toddler-C were adequate except for Variety of Stimulation (VS) subscale. For convergent validity, the correlation coefficients between AHEMD and HOME were 0.44 (p <0.05). Two subscales of motor toys of AHEMD demonstrated convergent validity with Learning Material subscale of HOME and some family variables in children with MD. Inside Space subscale of AHEMD correlated with family variables. Outside Space (OS) subscale of AHEMD was not significantly correlated with HOME or family variables.

Conclusion.?AHEMD-Toddler-C is a new measure option to explore the relationships between home environment and motor development in Chinese-speaking countries. Nevertheless, VS and OS subscales should be used cautiously.     

Perceived and performed infant care competence of younger and older adolescent mothers

The investigators examined differences in perceived and performed infant care competence for younger (less than 17 years of age) and older (17 to 19 years of age) adolescent mothers. Associations were tested between perceived infant care competence measured at several time points and performed mothering at 12 to 18 months infant age. A convenience sample of 78 adolescent mothers was recruited from two major teaching hospitals in Winnipeg, Canada. The Infant Care Questionnaire (ICQ), a self-report measure of infant care ability, was completed during the 3rd trimester and the 1st and 4th postnatal weeks. Performed mothering was assessed with Caldwell's HOME scale administered in the adolescent mother's home when the infant was 12 to 18 months old. Significant increases in competence perceptions over time were demonstrated for both ICQ subscales, the Mom&Baby, F(2, 47) = 22.73, p = 0.000, and Emotionality, F(2, 47) = 43.16, p = 0.000. This increase in infant care competence mirrors the maternal role competence trajectory reported in studies with older mothers. While no significant age group differences were found for Mom&Baby or Emotionality, older adolescent mothers were rated significantly higher on one of the HOME subscales, Variety in Daily Stimulation, t(n = 45), = 2.12, p =.04, and a second approached significance, Responsiveness, t(n = 45) = 1.86, p =.07. Pearson correlations between the Mom&Baby and Emotionality and the HOME subscales, Responsiveness and Environment, ranged between -0.30 and -0.37. Future research is required to further explain the negative correlations between perceived and performed infant care competence, establish clinical validity of self-report methods with adolescent mothers, and assess the influence of social, cultural, and economic factors not considered in this study.     

Psychometric properties of the Norwegian Person‐centred Climate Questionnaire from a nursing home context

Background: The physical and psychosocial environments in nursing homes influence the residents’ everyday life as well as their well‐being and thriving. The staff’s perceptions of and relationships with the residents are crucially important to quality care. Quality care is described often as person‐centred. Few measurement tools exist that focus on person‐centred care in nursing homes. Objective: The aim of this study was to evaluate the psychometric properties of the Norwegian version of the Person‐centred Climate Questionnaire–Staff version (PCQ‐S). Design: This study had a cross‐sectional survey design. Participants and Settings: Two hundred and nine healthcare and support staff in five nursing homes in the eastern part of Norway. Methods: The Swedish PCQ‐S was translated into Norwegian with forward and backward translation. The relevance of the items included in the questionnaire was assessed by an expert panel of 10 nursing home care staff, because the questionnaire has not been used in this context previously. A psychometric evaluation using statistical estimates of validity and reliability was performed. The discriminatory capacity of the questionnaire was also tested. Results: The content validity index was satisfactory (0.78). The PCQ‐S showed high internal consistency reliability in that Cronbach’s α was satisfactory for the total scale (0.92) and the three subscales (0.81, 0.89 and 0.87). The test–retest reliability was also satisfactory as evident from a Spearman’s correlation coefficient of 0.76 (p < 0.01) between the total PCQ scores at test and retest. The Norwegian version retained the original factor structure of the Swedish version. Conclusion: As the psychometric evaluation showed satisfactory validity and reliability scores, this study supports the Norwegian version of the PCQ‐S when applied to a sample of nursing home staff.     

Korean version of the Revised Caregiving Appraisal Scale: a translation and validation study

AIM: This paper is a report of a study to examine the reliability and validity of a Korean version of the Revised Caregiving Appraisal Scale with Korean caregivers of older stroke survivors. BACKGROUND: The Revised Caregiving Appraisal Scale was developed in the United States of America for an American English-speaking population to measure primary caregivers' appraisals of potential stressors and the efficacy of their coping efforts related to caregiving experiences. METHODS: Using the back-translation method, the instrument was translated into Korean. The Korean version of the Revised Caregiving Appraisal Scale was self-administered by 147 primary family caregivers recruited from three outpatient clinics and two home health agencies in Korea. The study was conducted in 2005. RESULTS: In this sample, Cronbach's alpha for the total scale was 0.86. Reliability coefficients for each of the five subscales ranged from 0.40 to 0.85. Two subscales, burden and satisfaction, showed good reliability; one subscale, impact, showed marginally acceptable reliability; two subscales, mastery and demand, had low reliability. Principal components factor analysis of the Korean version of the Revised Caregiving Appraisal Scale yielded six factors. Except for the mastery domain, which was divided into two factors, the other factors were similar to those in the original scale. CONCLUSION: The Korean version of the Revised Caregiving Appraisal Scale had adequate reliability and validity in a sample of Korean caregivers of stroke survivors. It can be used to assess the impact of caregiving and interventions on Korean caregiver attitudes. Further studies are needed with different categories of caregiver.     

早期家庭康复护理对脑梗死恢复期患者的影响

目的：观察早期家庭康复护理对脑梗死患者恢复期的影响。方法：选择住院治疗好转出院脑梗死患者82例，随机分为家庭护理组与普通对照组各41例，家庭护理组进行3个月家庭护理干预。对照组每月电话随访1次，进行相关康复护理指导。干预前后采用Barthel指数及汉密顿抑郁量表进行评分。结果：家庭护理组患者Barthel指数评分较干预前显著提高（P〈0．01），与对照组相比差异具有统计学意义（P〈0．05）。干预后家庭护理组患者抑郁量表评分较干预前明显下降（P〈0．05），与对照组相比差异具有统计学意义（P〈0．05）。结论：早期家庭康复护理能够显著提高脑梗死患者日常生活能力，减少抑郁症状，值得进一步推广应用。     

The structure of Antonovsky's sense of coherence in patients with schizophrenia and its relationship to psychopathology

The main aim of the study was to investigate whether the three hypothesized subscales of Antonovsky's sense of coherence (SOC) scale: comprehensibility, meaningfulness and manageability, can be found when measuring SOC in a sample of patients with schizophrenia living in the community. A further aim was to study the relationship between SOC and psychopathology. The concept of SOC has been proposed to explain successful coping with life stressors. A total of 120 patients completed the SOC scale and the Brief Psychiatric Rating Scale (BPRS) was used to assess the psychopathology of the patients. The SOC scale was analysed by means of a factor analysis with a varimax rotation and the Spearman rank correlation test was used to test for associations between subscales, factors and psychiatric symptoms. A four-factor model presented the best solution and explained 48% of the total variation in SOC. The first factor, which included 12-items of the SOC scale, turned out to be the most salient factor explaining 29% of the total variation. All factors displayed some overlapping between items. Affective symptoms were negatively related to all the three subscales and the four factors of SOC, while positive symptoms were similarly related to two of the subscales and two of the factors while negative symptoms were not associated with any of the factors or subscales. The findings in this study corroborate those in studies with other patient groups and indicate that the theoretical framework of SOC should not be adopted uncritically. Furthermore, the use of the three subscales in the SOC scale in studies of patients with a severe mental illness is questioned and a further investigation of the relationship between SOC and psychopathology is proposed.     

Parent-to-parent support initiated in the neonatal intensive care unit

A preliminary quasi-experimental, longitudinal study was conducted to explore differences in maternal mood states, self-esteem, family functioning, maternal-infant interaction, and home environment between mothers of preterm infants who participated in a nurse-managed program of parent-to-parent support and those who served as a comparison group. Mothers who participated in the intervention scored significantly higher on the Barnard NCATS interaction measure and the HOME total scale and subscales of maternal responsiveness and organization (N = 58) at 12 months following discharge from a neonatal intensive care unit. Using repeated measures analysis for a subset of mothers (n = 32), there were significant differences between the two groups on the mood state anxiety-tension (POMS) during the first 4 months postdischarge, with the treatment group having less anxiety. There was also a group by time interaction effect on self-esteem during the first 4 months, with self-esteem of the treatment group mothers increasing and comparison mothers decreasing. Findings suggest that one-to-one veteran parent support, in a nurse-managed program, may influence maternal and maternal-infant interaction outcomes. ©1995 John Wiley & Sons, Inc.     

The psychometric quality and clinical usefulness of three pain assessment tools for elderly people with dementia

In view of the need for valid, reliable, and clinically useful scales to assess pain in elderly people with dementia, this study evaluated the psychometric properties of translated versions of the PAINAD, PACSLAC, and DOLOPLUS-2 scales. In an observational study design, two raters simultaneously assessed the nursing home residents (n=128) for pain during influenza vaccination and care situations. The PACSLAC was valued as the most useful scale by nurses. Cronbach's alpha was high (>.80) for the total scale at T2 and T3 and adequate for the 'Facial expression' and 'Social/personality/mood' subscales. IC scores for the 'Activity/body movement' and 'Physiological indicators/eating/sleeping changes/vocal behaviors' subscales were low. It demonstrated good validity and reliability, although the scale should be further refined. This refinement should increase homogeneity. The PAINAD showed good psychometric qualities in terms of reliability, validity, and homogeneity (alpha ranged .69-.74 at T2 and T3) (except for the 'Breathing' item). The PAINAD scale had lower scores for clinical usefulness in this sample. The Dutch version of the DOLOPLUS-2 was considered more difficult to use but showed acceptable psychometric qualities in terms of the issues assessed, except for the 'psychosocial reactions' subscale. IC of the DOLOPLUS were adequate for the total scale (alpha ranged .74-.75) and almost all subscales (alpha ranged .58-.80). Findings of this study provide evidence of validity and reliability of the three pain assessment scales. Now that a pain scale is available, future studies also need to focus on its implementation in nursing practice.     

A comparison of life satisfaction and mood in nursing home residents and community-dwelling elders

This study compared life satisfaction and mood in a sample of 138 cognitively intact and ambulatory elders, including 70 who lived in nursing homes and 68 who lived independently in the community. Community-dwelling elders reported greater life satisfaction, and scored higher on the Vigor-Activity subscale of the Profile of Mood States (POMS) than those who lived in a nursing home. Nursing home residents scored higher on the Depression-Dejection, Tension-Anxiety, and Confusion-Bewilderment subscales of the POMS. No between group differences were shown on the Anger-Hostility and Fatigue-Inertia subscales of the POMS. The diminished life satisfaction and high depression found in the nursing home residents hold immediate implications for professionals who work in this area.     

Measuring behavioral and mood disruptions in nursing home residents using the Minimum Data Set

The Minimum Data Set (MDS) is a standardized assessment tool designed to provide a comprehensive biopsychosocial assessment of medical, behavioral, and cognitive status of nursing home residents. This pilot study examined the relationships of three MDS subscales--cognition, depressive symptoms, and behavioral disruptions--to other measures of the same domains (e.g., diagnosed dementia and depression and caregiver ratings on the Revised Memory and Behavior Problems Checklist [RMBPC]). The sample consisted of 135 nursing home residents with a mean age of 84 years. Based on the MDS, there was a high prevalence of cognition-related behaviors but a low prevalence of disruptive and depressed behaviors. The prevalence rates were substantially different according to the RMBPC. In addition, most of the MDS subscales failed to differentiate between residents with and without diagnosed dementia and depression, whereas caregiver ratings on the RMBPC did. The MDS and RMBPC subscales were modestly related but only in residents without dementia. These findings raise questions about the validity of the MDS in measuring nursing home residents' behavior, especially depressive and disruptive behaviors. Thus, caution should be employed in using the MDS as a sole outcome measure for these behaviors, and the use of multiple measures is suggested.     

Development and psychometric testing of the Wilmoth Sexual Behaviors Questionnaire-Female.

The purpose of this study was to develop and test the Wilmoth Sexual Behaviors Questionnaire-Female. As initially developed, the WSBQ-F consisted of 54 items arranged in 8 subscales. Items were rated on a Likert-type scale, with high scores reflecting more consistent use of a sexual behaviour. A convenience sample of 310 women with breast cancer (n = 165) and healthy women (n = 145) participated in the study. An Index of Content Validity of 1.00 was obtained. Construct validity was estimated using exploratory factor analysis and the known groups method. Internal consistency reliability was .94 for the total scale, with coefficients ranging between 0.52 and 0.94 for the subscales. The test-retest correlation coefficient was .81 for the total scale; coefficients were between .58 and .88 for the subscales. Initial testing of the measure suggests that the WSBQ-F is a reliable and valid measure of female sexual behaviours.     

持续社区家庭访视护理对回肠膀胱术后造口患者生活质量及肾功能的影响

目的 探讨持续社区家庭访视护理对回肠膀胱术后造口患者生活质量及肾功能的影响.方法 选取2012年1月～2014年3月在该院泌尿外科行全膀胱切除和回肠膀胱术后患者70例为研究对象,随机分为观察组和对照组各35例.观察组增加每月1次的家庭访视护理干预,连续干预24个月.采用膀胱癌特异性量表在出院后12、24个月分别评估两组患者的生活质量,分析两组患者在出院后12、24个月的肾小球滤过率(GFR)水平相对出院前的变化,调查患者出院后的生活质量评分相对出院前的改变值与GFR改变值的相关关系.结果 观察组患者在出院后12、24个月的各维度健康相关生活质量评分及总评分显著增加,与对照组相比,差异具有统计学意义(P<0.05);观察组患者在出院后24个月的GFR下降水平显著低于对照组(P<0.05);患者出院后24个月的生活质量评分改变值与GFR改变值存在显著相关关系(P<0.05).结论 持续社区家庭访视护理可有效提高回肠膀胱术后造口患者的生活质量水平,明显延缓肾功能损害的发生.     

Assessment of pain: can caregivers or relatives rate pain in nursing home residents?

Aim. To compare pain reports of nursing home residents to ratings by proxies. Background. It is not easy to assess pain in cognitively impaired residents. For residents who are unable to report pain intensity themselves, proxies (i.e. relatives or caregivers) might serve as sources of information. The utility of these proxies in assessing residents’ pain is not clear however. Design. A multicenter cross‐sectional study. Methods. Pain intensity was rated on a Numeric Rating Scale; proxies were asked how certain they were about their observations. Agreements on ratings were computed by means of intra class correlation (ICC) coefficients for continuous variables and multiple linear regression analyses were performed with the level of pain intensity by proxies as the dependent variable. Results. The sample consisted of 174 residents (median age 82 years), of whom 124 were cognitively impaired and 50 intact, and 293 proxies: 171 caregivers and 122 relatives. All three parties reported median pain intensity during the preceding week as 6·0. Data were consistent with low‐to‐moderate correlation coefficients between residents and caregivers (ICC = ?0·12 to 0·25), residents and relatives (ICC = ?0·51 to 0·48) and caregivers and relatives (ICC = 0·03 to 0·31). Residents themselves judged pain intensity at rest significantly higher than did proxies (p = 0·05). Caregivers scored significantly higher ratings for residents on analgesics (p = 0·001) and significantly lower pain ratings if they were more satisfied with the prescribed analgesics (p = 0·01). Conclusions. Proxy report of relatives and caregivers on presence and intensity of pain is unreliable, especially for cognitively impaired persons. The use of a standardised pain observation scale could be helpful. Relevance to clinical practice. Pain management in nursing home residents could be improved by educating caregivers about assessment and treatment of chronic pain. Relatives should be informed about chronic pain and learn how to alleviate pain through non‐pharmacological interventions.     

Developing and testing a tool to evaluate the quality of home aid services

This study aimed to develop a tool to measure the quality of home aid services in Taiwan. A 28-item scale for quality of home aid was drafter based on the literature; a cross-sectional survey was conducted for those using home aid services provided by long-term care centers in southern Taiwan. A total of 537 service users responded. Participants were randomly divided into two sample groups for item analysis (n = 102) and factor analysis (n = 435). Reliability was assessed by repeated measurements for 30 participants. During 2010–2011, a second survey was conducted and 590 questionnaires were collected.