Background The relationship between an increasing elderly population and wide-ranging neurological conditions has led to heightened rates of cognitive function impairment. Some researchers have found that health literacy risk may be associated with cognitive impairment in older adults. Objectives The purpose of this study was to delineate the difference in health literacy risk between older adults with mild cognitive impairment and those with normal cognitive function. Methods We conducted a survey study to explore the health literacy risk in older adults with and without mild cognitive impairment. Data were collected from 412 subjects between 60 and 91 years of age (260 without and 152 with mild cognitive impairment) between June and December 2016 in China. Cognitive function was measured using the Mini-Mental Status Examination, Montreal Cognitive Assessment, Global Deterioration Scale, Activities of Daily Living, and Hamilton Depression Rating Scale. Health literacy was measured using the Chinese Citizen Health Literacy Questionnaire. Results The scores of total health literacy and its three dimensions (basic health knowledge and mind, basic skills, and health lifestyle and behavior) were lower in those with mild cognitive impairment. Older adults with normal cognitive function had adequate or marginal health literacy levels, whereas those with mild cognitive impairment had marginal or inadequate health literacy levels. Using multiple logistic regression analysis, we found that health literacy risk, education level, age, marital status, and body mass index were independent risk factors for mild cognitive impairment. Discussion These results suggest that low health literacy may be a predictor of mild cognitive impairment. Screening for lower health literacy risk should be included in multidimensional geriatric evaluation.
Background The Tanzanian health sector suffers from shortages of healthcare workers as well as uneven distribution of healthcare workers in urban and rural areas. Task shiftingdelegation of tasks from professionals to other healthcare team members with less training, such as medical attendantsis practiced, compromising quality of care. Advanced practice nursing is underutilized. Objective The purpose of this study was to explore the views of nurses and physicians on current responses to shortages of healthcare workers and the potential for utilization of advanced practice nurses. Methods A descriptive, qualitative design was used. Purposeful sampling was used to select 20 participants. An in-depth interview guide was used to obtain information. Interviews were conducted in Swahili or English. Content analysis was used to identify themes. Results Shortage of human resources in rural primary healthcare facilities was identified as a major rationale for implementation of the advanced practice nurse practitioner role because the current health providers in rural health facilities are less trained and doctors are not ready to work in these settings. Opposition from physicians is expected during the course of implementing the nurse practitioner role. Professional bodies and government should reach consensus before the implementation of this role in such a way that they should agree on scope and standards of practice of nurse practitioners in Tanzania. Conclusion Shortage of human resources for health is greater in rural primary healthcare facilities. Task shifting in Tanzania is neither effective nor legally recognized. Transition to advanced practice nursing rolesparticularly the nurse practitioner rolecan facilitate provision of optimal care. Nurse practitioners should be prepared to work in rural primary healthcare facilities.
Background Beginning in the late 1950s and intensifying through the 1960s and 1970s, nurse educators, researchers, and scholars worked to establish nursing as an academic discipline. These nursing leaders argued that the development of nursing theory was not only critical to nursing's academic project but also to improving nursing practice and patient care. Objectives The purpose of the article is to examine the context for the development of nursing theory and the characteristics of early theory development from the 1950s through the early 1980s. Methods The methods used were historical research and analysis of the social, cultural, and political context of nursing theory development from the 1950s through the early 1980s. How this context influenced the work of nurse theorists and researchers in these decades was addressed. Results The development of nursing theory was influenced by a context that included the increasing complexity of patient care, the relocation of nursing education from hospital-based diploma schools to colleges and universities, and the ongoing efforts of nurses to secure more professional autonomy and authority in the decades after World War II. In particular, from the 1960s through the early 1980s, nurse theorists, researchers, and educators viewed the establishment of nursing science, underpinned by nursing theory, as critical to establishing nursing as an academic discipline. To define nursing science, nurse theorists and researchers engaged in critical boundary work in order to draw epistemic boundaries between nursing science and the existing biomedical and behavioral sciences. Discussion By the early 1980s, the boundary work of nurse theorists and researchers was incomplete. Their efforts to define nursing science and establish nursing as an academic discipline were constrained by generational and intraprofessional politics, limited resources, the gendered and hierarchical politics, and the complexity of drawing disciplinary boundaries for a discipline that is inherently interdisciplinary.
Background: Understanding caregiver's perceptions of their family member's memory loss is a necessary step in planning nursing interventions to detect and address caregiver burden. Objective: The purpose of this study was to characterize caregivers' perceptions of their family members' memory loss and identify potential correlates within Leventhal's common sense model (CSM). Methods: This secondary analysis used baseline data from a larger randomized controlled trial. Patients with memory loss and their caregivers (N = 83 dyads) from the community were included, The adapted Brief Illness Perception Questionnaire (BIPQ) assessed caregivers' illness perceptions. Eight additional instruments measured correlates within the CSM. Responses were described; multiple linear regression was used to predict BIPQ dimension scores, and logistic regression was used to predict dichotomized BIPQ scores. Results: Most caregivers were female, White, and spouses of the patients; they reported a range of perceptions on the nine BIPQ dimensions. Patients' cognitive function consistently emerged as a significant correlate of caregivers' illness perceptions, explaining the most variance in caregivers' perceived consequences, identity, and treatment control (p < .01). Caregivers' reactions to patients' behavioral symptoms and caregivers' trait anxiety were associated with perceived illness coherence (p < .01), Caregivers with higher severity of daily hassles and White caregivers perceived that their family members' memory loss would last longer (p < .001). Discussion: Caregivers' perceptions of family members' memory loss varied; distinct dimensions of caregivers' illness perception were associated with a range of clinical and psychosocial factors. This exploratory study demonstrates the complexity of applying the CSM to caregivers of persons with memory loss.
Background: For the stabilization of the nursing profession in mainland China, a valid and reliable nursing work environment instrument, grounded in China's context, should be developed to better provide rigorous evidence for policy makers. Objective: The purpose of the current research was to further develop a scale that could capture the characteristics of the nursing work environment in mainland China. Methods: A convenience sample of 542 nurses employed in a tertiary hospital of mainland China completed the 108-item Chinese Nursing Work Environment (C-NWE) Scale (1st ed.). Items that did not differentiate between respondents with the highest and lowest 27% of total scores and those that did not meet criteria for factor loadings were set aside. Exploratory factor analysis based on the maximum likelihood method was used to identify the structure of the scale. The chi-square test was used to evaluate model fit, and expert review was conducted to test content validity. Reliability was estimated using Cronbach's alpha coefficient. Results: The revised C-NWE Scale, which consists of nine subscales and 47 items, is a simplified version of the C-NWE (1st ed.). Using exploratory maximum likelihood factor analysis, the normed chi-square fit index for a nine-factor solution was 1.97. The content validity index for the total scale was 0.93; Cronbach's alpha was.94. Discussion: Initial evidence of the psychometric properties of C-NWE scores was presented. Further studies could be conducted in various settings to identify the C-NWE Scale's validity and reliability.