Study findings underscore the importance of targeting both DCW-level and organizational-level factors to increase DCW job satisfaction.
Purpose: Research underscores how autonomy and decision-making involvement may help to enhance the quality of life of older adults; however, individuals with dementia are often excluded from decision making that is related to their daily functioning. In this study we use a modified version of the Stress Process Model to consider the stress process of individuals with chronic illness, and in particular to explore the predictors of decision-making involvement among individuals with dementia (n = 215). Design and Methods: We collected data from individual with dementia (IWD)-family caregiver dyads. Relying primarily on data from the IWD, we used hierarchical multiple regression analysis to determine the predictors of the IWD's decision-making involvement. Results: Results indicate that individuals who report more decision-making involvement are younger, female, have more education, have a nonspousal caregiver, have fewer months since their diagnosis, exhibit fewer problems with activities of daily living and fewer depressive symptoms (based on caregiver report), and place more importance on autonomy/self-identity. Implications: In our discussion we examine the importance of autonomy and impairment levels for understanding the decisionmaking involvement of persons with dementia.Key Words: Autonomy, Daily functioning, Impairment, Stress process, Well-being Approximately 24 million people in the world have dementia, and the leading cause of dementia is Alzheimer's disease (Alzheimer's Disease International, 2006). In the United States it is estimated that 4.5 million people have Alzheimer's disease, and that the number of people with dementia is increasing (Alzheimer's Association, 2005). As the prevalence of dementia increases nationally and internationally, social science research on individuals with the diagnosis of dementia (from here on referred to as IWDs) has also expanded. When social research about Alzheimer's disease and dementia flourished in the 1980s, practical difficulties were sometimes encountered that precluded involving IWDs in social science research. Some researchers argued that these individuals were unable to provide meaningful or reliable responses to quantitative research questions (Albert et al., 2001;Kerner, Patterson, Grant, & Kaplan, 1998). At the same time, there was a growing body of qualitative research and anecdotal evidence that noted IWDs' ability to share insights and make decisions about how to live their lives (Davis, 1989;McGowin, 1993;Menne, Kinney, & Morhardt, 2002;Sabat & Collins, 1999). These differing opinions on the ability of IWDs to be involved in research and in their own care planning remain a matter of debate. In addition, writings about quality of life suggest that the autonomy and decision-making preferences of frail older adults are important factors when it comes to understanding an individual's quality of life (Lawton, 1991;Wetle, 1991).One area of research that examines the involvement of IWDs in making decisions concerns advanced directives and whether or not an ...
The proposed SPM for IWDs serves as a guide to (a) consider and understand the short- and long-term complexities of the illness experience for IWDs, (b) investigate specific hypotheses by outlining key stressors in the illness experience and by positing relationships among stressors and outcomes, and (c) help inform the development of interventions to prevent or reduce the negative stressors and enhance the positive experiences of living with a dementing illness.
This report describes the development and preliminary psychometric properties of the Decision-Making Involvement Scale for individuals with dementia and family caregivers. Data were collected from 217 individuals with dementia and their respective caregivers. Principal axis factor analysis, Kendall tau, and Pearson correlations were used to determine the Decision-Making Involvement Scale's psychometric properties, mean differences of caregiver and individual with dementia, and the relationship between scores of Decision-Making Involvement Scale and measures of well-being. Analyses support a reliable, 1-factor solution of the Decision-Making Involvement Scale for both individuals with dementia and caregivers. Socio-demographic, impairment, and well-being variables are differentially related to the perceptions of how involved the individual with dementia is in decision making. The Decision-Making Involvement Scale provides useful information about daily decision making of an individual with dementia, and it shows promise as a means for understanding the relationship between decision-making involvement and well-being of individuals with dementia and caregivers.
This research applies a stress-and-social-support conceptual model to investigate the effects of personal and facility characteristics, job-related and personal stressors, and social support in the workplace on nursing assistant (NA) satisfaction with supervision. Survey data are from in-person interviews with 338 NAs employed at 22 skilled nursing facilities. Structural equation modeling was used to determine the model's goodness of fit. Results show that personal stressors (family, financial, and health concerns) have the greatest impact on satisfaction with supervision. Positive support in the workplace attenuated the effects of job-related stressors on the outcome. Findings suggest NAs' personal stressors require careful attention from supervisory and human resources staff because they directly affect worker satisfaction with supervision. Employee Assistance Programs and training for supervisors in team building, communication, and motivational skills are needed to promote more positive relationships with and among NAs.
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