Joan S. Grant

Doctor of Nursing Practice (DNP)-prepared faculty often enter academia with rich clinical experiences but face unique challenges meeting academic scholarly expectations. Early efforts can be overwhelming, riddled with challenges, pitfalls, and rejection. These experiences impact new faculty transitions, reducing self-esteem, and lowering job satisfaction. New faculty commonly contribute to one or more academic missions of teaching, and service yet need support identifying appropriate scholarship pathways. This paper identifies barriers associated with scholarly activity for DNP-prepared faculty. It also provides academic leaders with targeted strategies to mentor DNP-prepared faculty in identifying, developing, and sustaining a focused scholarly trajectory. Examples of behaviors that promote the success and impact of scholarship are provided. By cultivating focused mentorship and opportunities for scholarship, leaders can promote professional growth, increase retention, and advance the visibility and impact of DNP-faculty scholarship.

Background: Heart failure (HF) is a common chronic illness in the United States, and rural individuals have a higher risk of this disease, often with negative health outcomes. While dyads cope more effectively in working together to address heart-related problems, there are few innovative studies exploring the acceptability and usefulness of self-care partnership programs to assist rural dyads in managing symptoms and daily challenges. Purpose: We examined the acceptability and usefulness of a telephone problem-solving program with HF dyads for managing HF-related problems in the home. Self-care areas, process outcomes, and underlying structures and patterns regarding acceptability and usefulness were addressed. Methods: Data for this qualitative descriptive study were collected via individual telephone interviews with 29 HF dyads, using an investigator-developed semi-structured interview guide. This analysis focused on the midpoint, in-depth, 5-week analysis of the 12-week parent study to compare early and later data regarding acceptability and usefulness. Adjusted matrix analyses and multiple correspondence analysis were used to address the study aims. Results: Most dyads were completely supportive of the program, and 12 suggested strategies for improving its usefulness. Most dyads focused on self-care maintenance (diet, exercise) problems and self-monitoring (abnormal signs and symptoms). A gender pattern difference was identified in addressing self-care maintenance problems. Conclusion: Our study fills an important gap regarding collaborative transition and empowerment of self-care in rural HF dyads. It also highlights the need for longitudinal research on how gender pattern differences influence self-care in rural dyads.

High cost of prescription drugs is a common reason why patients stop taking medications, or don't fill a prescription. There are cost savings plans available, but these resources vary by eligibility criteria, and each has advantages and disadvantages. The article reviews some of the available cost saving options.

Background: The reliability and validity of the subjective component of the Dutch Objective Burden Inventory (DOBI) are unknown. Objective: The validity and reliability of the subjective component of the DOBI were examined in caregivers of individuals with heart failure, using the original 38- and a 24-item version. Methods: In an online cross-sectional investigation, confirmatory factor analysis was used to examine factorial validity. In examining convergent validity, corrected item-dimension correlations assessed item performance and associations between subjective subscale scores and the Bakas Caregiving Outcomes Scale. Cronbach's α examined internal consistency. Results: The original 4-factor solution was retained and both the original and shorter versions of the subjective component of the DOBI supported adequate construct validity and internal consistency. Conclusions: Both the 38- and 24-item forms of the subjective DOBI supported construct validity and reliability. Further studies examining the usefulness of both versions are needed in carers of individuals with more severe HF.

RRH: Rural and Remote Health. Published article number: 6497 - Psychosocial predictors of adverse outcomes in rural heart failure caregivers

Diabetes is a public health problem and a major risk factor for cardiovascular disease, the leading cause of death in the United States. Diabetes is prevalent among underserved rural populations. The purposes of this study were to perform secondary analyses of existing clinical trial data to determine whether a diabetes health promotion and disease risk reduction intervention had an effect on diabetes fatalism, social support, and perceived diabetes self-management and to provide precise estimates of the mean levels of these variables in an understudied population. Data were collected during a cluster randomized trial implemented among African American participants (n = 146) in a rural, southern area and analyzed using a linear mixed model. The results indicated that the intervention had no significant effect on perceived diabetes management (p = 0.8), diabetes fatalism (p = 0.3), or social support (p = 0.4). However, the estimates showed that, in the population, diabetes fatalism levels were moderate (95% CI = (27.6, 31.3)), and levels of social support (CI = (4.0, 4.4)) and perceived diabetes self-management (CI = (27.7, 29.3)) were high. These findings suggest that diabetes fatalism, social support, and self-management perceptions influence diabetes self-care and rural health outcomes and should be addressed in diabetes interventions.

Background: Psychometric properties of the 38-item version of the Dutch Objective Burden Inventory (DOBI) have been evaluated primarily in older female caregivers, with no published studies that vary by a different gender and age distribution. Objective: The aim of this study was to test the construct validity and reliability of the DOBI in caregivers of individuals with heart failure from the United States and other countries. Methods: This secondary analysis from a cross-sectional study used an online survey. Factorial validity was tested with confirmatory factor analysis, item performance was examined with ordinal item response analysis, and convergent validity was tested correlating DOBI subscale scores with Bakas Caregiving Outcomes Scale scores. Internal consistency reliability was assessed with Cronbach α. Results: Item response analysis removed 14 items. Confirmatory factor analysis retained the original 4-factor solution. Original and reduced instruments demonstrated good internal consistency. Validity was supported by meaningful associations with the Bakas Caregiving Outcomes Scale. Conclusions: Both the original 38-item DOBI and the reduced 24-item DOBI had support for their construct validity and internal consistency. The 24-item DOBI may be a useful alternative to the 38-item version, because it maintains psychometric properties of the original instrument while decreasing data collection burden. However, more research is needed to assess whether the shorter version is useful in assessing objective caregiving burden.

Palliative care initiatives strive to control symptoms and improve the quality of care for individuals with heart failure (HF) and their informal caregivers. Yet, caregiving is stressful for many caregivers and requires a delicate balancing act between providing quality care and maintaining other responsibilities. Support services are a crucial component of palliative care. Yet, little is known regarding what support services HF caregivers need to assist with caregiving duties. Thus, the purpose of this study was to identify support services informal caregivers perceive would be useful in caring for individuals with heart failure in the home. This secondary analysis was part of a cross-sectional, descriptive, exploratory study which included 530 heart failure caregivers, using an online self-report instrument. Content and quantitative data analyses were conducted. Caregivers were primarily Caucasian (n = 415; 78.3%) male (n = 270; 50.9% male), with an average age of 41.4 (±10.4) years. Individuals with heart failure were mostly male (n = 297; 56.0%), age 54.3 (± 14.8) years of age and had New York Heart Association Class I-II heart failure (n = 375; 70.7%). Needed support services identified by caregivers related to cost effective heart failure support, caregiver information/education/training, and caregiver support. These services had two or more components. Caregivers of individuals with heart failure experience complex problems in the home that require important services to enhance palliative care. Exploring ways to provide these important support services will assist in the development of interventions to reduce negative outcomes and enhance heart failure palliative care.