In the article by Yeh & Bull (2009), spirituality of family caregivers were being described
and also the relationships of coping, spiritual well-being, and mental health of family caregivers
for the elderly who were recently hospitalized with heart failure. Spiritual well-being, coping
strategies, and mental health were all being measured using tools like the JAREL Spiritual Well-
Being Scale (SWBS), the Carers’ Assessments of Managing Index (CAMI), and the Symptom
Questionnaire. It was then concluded that the spiritual well-being was linked to the
improvement of mental health and the family caregivers’ positive coping was also linked to the
improvement of mental health (Yeh & Bull, 2009).
The theoretical framework used was the modification of the stress, coping, and adaptation
model by Lazarus and Folkman. This theoretical framework was good for the study, in that it
allowed for the study to be conducted within the concepts of this model. This model looks at
causal antecedents, mediating processes, and long term effects as it pertains to the caregivers’
role in caring for the patient with congestive heart failure (CHF). These factors allow for a
systematic explanation of how spirituality is used as a coping mechanism or a mediating process
to cope with the stresses involved in taking care of the loved one with CHF (Yeh & Bull, 2009).
The concept of spiritual well-being was defined as being multidemensional. Some facets
of this concept included religion, faith, and self-actualization and can be viewed as a protective
factor in stressful circumstances. There was really no other description given for this concept
other than the factors included in the SWBS. Factors included prayer, life purpose, belief in a
supreme power, and life change acceptance. Another concept of religiosity was mentioned in the
article. There was no real operational definition given here, just the explanation of how it was
linked with less depressive symptoms of caregivers with families with dementia and mental
illness, and those with bereaved family caregivers. Spiritual well-being was measured using the
SWBS, a 21-item measurement tool that included three subscales of faith/belief, life/self-
responsibility, and life satisfaction/self-actualization. The higher the score indicated higher
spiritual well-being (Yeh & Bull, 2009).
The validity of the SWBS was confirmed using factor analysis and content validity. The
information from the use of the factor analysis and content validity was then used to determine
the internal consistency reliability. Internal consistency reliability is measured by assessing
homogeneity, which is the degree items on a multiple item tool are consistent with one another
(Heavy, 2015). Once homogeneity is determined the instrument is said to have internal
consistency reliability. Measurements such as family support use internal consistency reliability
as a useful tool to measure concepts. Concepts are usually assessed using Cronbach’s alpha,
where ‘0’ means no reliability in the instrument scale, and ‘1’ means perfect reliability. The
CAMI scale used Cronbach’s coefficient to test the internal consistency reliability to assess
family caregivers’ coping strategies. The validity of this instrument was not specifically
addressed in the article. In the SQ scale convergent validity was used to measure or test
accuracy. Convergent validity uses survey results, previously measured to compare with current
survey results of a measurement tool. Previous SQ and observer rating scales were used in this
study to support convergent validity. Cronbaach’s coefficient was also used to test internal
consistency reliability (Heavy, 2015).
While reading the article, it was rather interesting to learn of the different ways of
measuring concepts. Cronbaach’s coefficient was new to me, but was able to refer to my
textbook for clarity on this test. Interpreting statistical scores for concepts is a tedious process,
although most concepts are abstract in nature. To bring abstract concepts down to practical levels
with the use of statistical measurement was most fascinating to me. Also after reading this
article, I realized that all types of concepts can be accurately measured once the right tools are
used.
The nursing profession is unique when looking at the nature of our practice. Nurses are
taught to look at the human as a whole, combining the physical, mental, and emotional aspects of
the individual and relating them to our clinical practice of healing. This is not to say that doctors
do not incorporate these different aspects, however, as nurses, we are taught that with providing
direct medical care, we also need to consider the different aspects of the individual when giving
care. As nurses, we take pride in not just the physical healing aspect of care, but our patients
(clients) experience healing on a more holistic level, providing for a more fulfilling experience.
As a DNP prepared nurses, the ability to have a clear understanding of concept as it
relates to nurses, allows for structure and clarity of various nursing phenomena that typically are
viewed as vague or abstract (Chinn & Kamery 2011). As a DNP prepared nurse, we will be
expected to utilize not just nursing theories, but theories acquired from other practices to be able
to predict the quality and importance of health-related phenomena and to come up with ways in
which to improve different phenomena. Concepts and conceptual models will lead to the
development of grand theories relating to nursing (Chism 2013). According to The Essentials of
Doctoral Education for Advance Nursing Practice, the DNP student will be prepared to “develop
and evaluate the new practice approaches based on nursing theories and theories from other
disciplines” (AACN, 2006, p. 9).
Increase relapse rate of young adults addicted to heroin represents a clinical problem
typically present in my practice. The concept of recovery will be what I plan on using as a focus
on developing and implementing my practice change project. In regards to population
differences, recovery could mean the re-establishment of a particular people or groups of people
to a certain area. When I think of population differences, Hurricane Sandy comes to mind. In
2011, the Jersey Shore was drastically affected by this storm. As a result, many residents had to
re-locate to shelters, temporary housing, or family members. When looking at the recovery rate
of individuals and families, we think of the number of residents moving back to their homes. In
this usage of the word recovery, we think of the migration of people to a certain area, as opposed
to how one would look at the work if it was used in the context of substance abuse. Cultural
differences on the view of recovery may vary on how it is perceived. To a certain group of
people, recovery can be a positive process. For example, this group could have had a history of
substance abuse, where most of their family members could not maintain recovery for a
significant amount of time. In another group, the members would not know anyone who had to
struggle with substance use, therefore, their own view of recovery could be negative.
The concept of recovery can be used in different fields. Some examples include the use of
recovery in sports, where a loose ball or fumbled ball can be recovered in football. In the legal
system, the term recovery under law refers to the right of the legal system to obtain property.
Even economically, the concept of recovery is customized to mean the re-establishment of gross
domestic products that were once lost (Brennaman & Lobo).
With respect to other disciplines or areas of study, recovery for a physical therapist could
be the use of an extremity that was once injured. To a cardiologist, recovery could mean the
period of time following open heart surgery where patients are given time to allow their bodies to
return to their pre-surgical state.
Recovery is a broad concept that has several meanings. While working on my
practice change project, I plan on using this term as the main goal and focus of treatment and to
then, be able to utilize treatment approaches that would further benefit heroin addicts to maintain
the recovery long term.
References
American Association of Colleges of Nursing (AACN). (2006). Essentials of doctoral education
for advanced nursing practice. Retrieved from www.aacn.nche.edu/publications/position/
DNPEssentials.pdf
Brennaman, L., Lobo, M. (2011). Recovery from serious mental illness: A concept analysis.
Issues in Medical Health Nursing,32, 654-663. doi: 10.3109/01612840.2011.588372
Chinn, P. and Kramer, M. (2011). Integrated theory and knowledge development in
nursing.(8th ed.) St. Louis, MO: Elsevier Mosby
Chism, L. A. (2013). The doctor of nursing practice: A guidebook for role development and
professional issues. (2nd ed.). Burlington, MA: Jones & Bartlett.
Heavy, E. (2015). Statistics for nursing: A practical approach. Burlington, MA: Jones & Barlett
Learning.
Yeh. P-M. & Bull, M. (2009). Influences of spiritual well-being and coping on mental health of
family caregivers of elders.GResearch in Gerontological Nursing, 2(3), 173-181.
