Discussion: Effects of family oriented communications skills

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Discussion: Effects of family oriented communications skillsDiscussion: Effects of family oriented communications skillsYou should read the article ( Effects of family oriented communications skills training ).here the Instruction,1. Write a summary of the article—label this paragraph Summary 100 to 150 words.2. The second thing ,write a critical analysis of the article–label this paragraph Critical Analysis 150 to 200 words3- write your opinion about this article . use at least 60 words . Discussion: Effects of family oriented communications skills5- Must have a cover page APA style format. effects_of_famNurs Midwifery Stud. 2016 March; 5(1): e28550. doi: 10.17795/nmsjournal28550 Research Article Published online 2016 February 20. Effect of a Family-Oriented Communication Skills Training Program on Depression, Anxiety, and Stress in Older Adults: A Randomized Clinical Trial 1 2,* 1 1 Zahra Ghazavi, Simin Feshangchi, Mousa Alavi, and Mahrokh Keshvari 1Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran 2Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran *Corresponding author: Simin Feshangchi, Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran. Tel: +98-9133013860, Fax: +98-3136699398, E-mail: feshangchi.simin@yahoo.com Received 2015 March 9; Revised 2015 October 18; Accepted 2015 October 19. Abstract Background: Older adults face several physical and psychological problems such as hearing loss, vision loss, and memory loss, which diminish the quality of their communication. Poor communication in turn affects their psychological wellbeing and induces substantial depression, anxiety, and stress. The family has an important role in the mental health of older adults. Objectives: This study aimed to investigate the effect of a family-oriented communication skills training program on depression, anxiety, and stress in older adults. Patients and Methods: For this randomized controlled clinical trial, we enrolled 64 older adults from two healthcare centers affiliated to the Isfahan University of Medical Sciences. The subjects were randomly allocated to an experimental group (n = 32) and a control group (n = 32). In the experimental group, older adults along with their primary caregiver participated in six sessions of communication skill education. The control group participated in two training sessions on nutrition and exercise. All participants answered the DASS21 questionnaire three times—at the start of the study, at the end of the sixth week, and a month after the last educational session of the experimental group. Data were analyzed using chi-square, Fisher’s exact and t tests and by repeated measures analysis of variance (ANOVA). Results: In the experimental group, the mean depression score significantly reduced from 10.56 ± 3.34 before intervention to 7.46 ± 2.80 and 6.30 ± 2.75 after intervention and at follow-up, respectively; the mean anxiety score significantly reduced from 8.46 ± 1.88 before intervention to 5.83 ± 1.93 and 5.80 ± 2.12 after intervention and at follow-up, respectively; and the mean stress score significantly decreased from 11.40 ± 4.53 before intervention to 8.90 ± 3.81 and 8.43 ± 3.31 after intervention and at follow-up, respectively (P < 0.05 for all three domains). In contrast, the control group did not show any significant change in the mean depression, anxiety, and stress scores. Conclusions: Family-oriented education on communication skills could reduce depression, anxiety, and stress in the elderly. Therefore, such programs should be adopted as a non-pharmacological and cost-effective method for reducing depression, anxiety, and stress in older adults. Effects of family oriented communications skills. Discussion: Effects of family oriented communications skillsKeywords: Family, Depression, Anxiety, Stress, Caregivers, Communication skills, Elderly 1. Background Aging population is one of the main challenges in this century. Since the start of the 20th century, life expectancy has increased by 30 years (1), and this trend will continue in future (2). And, Iran is not an exception to witnessing this trend (3, 4). Aging causes physiological changes that diminish an individual’s physical, mental, and social capabilities (5), and predisposes older adults to various physical and psychological diseases (6). Approximately 15% of people aged 60 years or more experience a mental disorder (7). Depression, anxiety, and stress are common among the elderly, with 25% older adults suffering from one of these disorders (8, 9). These disorders can lead to extreme outcomes such as suicide (10), and often affect their family and caregivers by causing chronic tension and negatively affect the quality of care extended to older adults (11). There are several causes for depression, anxiety, and stress in older adults. The common ones include relocation, loss of spouse or close friends, decrease in physical and functional abilities, and loss of independence (12); loneliness (13, 14); loss of job and increase in financial dependency (15); chronic diseases and pain (16); and decrease in senses (17). Communication skills of older adults are among the important predictors of their mental health (18). Poor communication skills can not only evoke anxiety, depression, and stress (19) in older adults but also predispose them to social isolation and loneliness (20). Appropriate communication skills are important for both older adults and their family members, and for their adequate participation when being treated for Copyright © 2016, Kashan University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. Ghazavi Z et al. psychological problems (21, 22). Good communication skills empower people to establish a more effective and sustainable communication, whereby they can exchange precise messages and effectively manage familial conflicts and disputes, and thus enjoy a more stable family life (19), as well as experience less stress under stressful situations (23). A recent study showed that older adults with regular family contacts are more adaptable and have higher levels of psychological wellbeing (24). Runcan reported that communication skills training of caregivers of the elderly with Alzheimer’s disease resulted in a decrease in their perceived stress (22). Further, communication skills training could also reduce stress levels in nurses working in psychiatric units (25). According to a systematic review, health education programs for caregivers improve their knowledge, attitude, and perception toward older adults and, consequently, improve hygiene among elderly people (26). However, also not in the elderly or their caregivers, Curtis et al. reported that medical residents and nurse practitioners who passed a communication skills training program showed higher levels of depression after communication with patients and older adults with serious illness (27). The conflicts mentioned above, lack of relevant studies in Iran, awareness of the effects of socio-cultural factors on the aftermath of educational interventions, and the fact that family-centered communication skills training is a new theme in elderly care, all raise a pertinent question: “can a training program in communication skills for older adults and their families improve relationships within the family and psychological wellbeing of older adults? Effects of family oriented communications skills. Discussion: Effects of family oriented communications skillsORDER NOW FOR CUSTOMIZED AND ORIGINAL NURSING PAPERS2. Objectives The present study aimed to investigate the effect of a family-oriented communication skills training program on depression, anxiety, and stress scores in older adults visiting two healthcare centers affiliated to the Isfahan University of Medical Sciences. 3. Patients and Methods This clinical trial was conducted from September through October 2014 on aged people visiting Imam Ali (PBUH) and Dastgerd healthcare centers in Isfahan, Iran. The sample size was calculated based on a study by Mansouri et al. who examined the effect of communication skills training on perceived stress of caregivers of elderly patients with Alzheimer’s disease; they reported that after the intervention, the mean ± SD of stress in the control and the experimental groups was 30.14 ± 8.07 and 24.83 ± 5.86, respectively (25). For the present study, considering β = 0.2, α = 0.05, S1 = 8.07, S2 = 5.86, μ1 = 30.14, and μ2 = 24.83, 26 subjects would have to be enrolled in each group. However, considering the subjects’ physical condition and a drop-out rate of 18%, 32 subjects were to be recruited in each group. The inclusion criteria for the main caregivers were as 2 follows: ability to read and write in Farsi, willingness to participate in the study, full consciousness, absence of a known physical and mental disability or any psychiatric/ behavioral disorder, and not receiving antidepressant, anxiolytic, and anti-stress medications. The inclusion criteria for the elderly were, in addition to the ones mentioned above, age ≥ 60 years and mild to moderate scores for depression, anxiety, and stress based on the DASS21 inventory. The following were the exclusion criteria for the elderly and their main caregivers: consumption of any antipsychotic medications during the study, a decision to withdraw from the study, absence for more than two training sessions, and death. After receiving approval for the study, a simple random sampling method was used. First, a list of all urban healthcare centers affiliated to the Isfahan University of Medical Science was prepared. Thereafter, using a random numbers table, two centers were randomly selected from among the 58 centers (i.e., Imam Ali canter and Dastgerd centers). All of the existing records in the selected centers were reviewed to find families with older adults that meet the inclusion criteria. Next, using a random numbers table, 32 subjects were selected from each center. Next, using the “random numbers” option in the “compute” and “function group box” in the transform menu of the SPSS software, the 32 subjects from each healthcare center were randomly divided to two equal subgroups containing 16 subjects, and the two subgroups in each center were randomly assigned either to the experimental or the control group. Thereafter, the patients were contacted; invited to participate in the study; and upon consent, were invited to attend a session, on a predetermined date, at the concerned healthcare center with one of their family members with whom they share a better relation (designated, their primary caregiver). If an elderly patient refused to participate or was inaccessible, another suitable one was selected, as mentioned previously. On the day of the visit to the center, the elderly and their primary caregivers received an explanation of the goals and method of the study (separately to each group), signed a written informed consent, and received the study instrument. Effects of family oriented communications skillsThe older adults were asked to answer the questionnaire individually in a private environment, without any stress. 3.1. The Study Instrument The data collection instrument consisted of two sections. The first section comprised questions on demographic characteristics (i.e., age, gender, marital status, education level, financial status, number of the family members living together, and number of children). The second section included the 21-item depression, anxiety, and stress scale (DASS21). The DASS21 includes 21 items for evaluating depression (7 items), anxiety (7 items), and stress (7 items). All items are answered on a fourpoint Likert scale, ranging from never (= 0) to so much Nurs Midwifery Stud. 2016; 5(1):e28550 Ghazavi Z et al. (= 3) (28). The following scores have been developed for defining normal, mild, moderate, severe, and very severe scores for each DASS scale. Depression: (0 – 4) normal, (5 6) mild, (7 – 10) moderate, (11 – 13) severe, and (over 14) very severe. Anxiety: (0 – 3) normal, (4 – 5) mild, (6 – 7) moderate, (8 – 9) severe, and (over 10) very severe. Stress: (0 – 7) normal, (8 – 9) mild, (10 – 12) moderate, (13 – 16) severe, and (over 17) very severe (29). The validity of the Farsi version of the DASS21 has been previously established by Sahebi et al. through concurrent validity (using Beck depression inventory, Zank anxi- ety scale, and perceived tension scale) (30). Its reliability was also established by a Cronbach’s alpha of 0.93 (31, 32). 3.2. Intervention At each healthcare center, the family members and the older adults of the experimental group participated in six weekly (28) sessions of family-oriented education on communication skills. Each 45-minute session was delivered by a previously trained geriatric nurse. Table 1 outlines the educational sessions. Table 1. Outline of the Educational Sessions No. 1 2 3 4 5 6 Title of Sessions Contents of Each Session Time, min Greeting, explaining the rules and basic concepts Greeting; introducing the program facilitator, explaining the number and structure of the training sessions; presenting the positive aspects and the aftermaths of good communication; and providing the basic rules of group discussion 45 Consequences of lacking communication skills Greeting; reviewing the content of the previous session and receiving feedback from the participants; discussing the short-term and long-term consequences of poor communication skills; asking the older adults and caregivers to summarize the contents of the session 45 Active listening and effective questioning Greeting; reviewing the content of the previous session and receiving feedback from the participants; discussing the types of listening, the purposes of listening, principles and techniques of active listening, and common errors in listening; discussing the right way of effective questioning; and asking the older adults and caregivers to summarize the contents of the session 45 Introducing body language, tone of voice of speech, and healing touch skills Greeting; reviewing the content of the previous session and receiving feedback from the participants, discussing the importance of body language, tone of voice of the speech; types of touching and principles of the healing touch; and asking the elderly and caregivers to summarize the contents of the session 45 Introducing the effects of empathy in reducing the sense of isolation and anger Greeting; reviewing the content of the previous session and receiving feedback from the participants; discussing the importance of empathy, skills for anger control, and using self-relaxation techniques and negotiation and dialogue in stressful situations; and asking the elderly and caregivers to summarize the contents of the session. Effects of family oriented communications skills45 Communication skills needed to communicate with elderly who have communication and agerelated disorders Greeting; reviewing the content of the previous session and receiving feedback from the participants; discussing communication skills needed to communicate with the elderly who have communication disorders such as hearing loss, vision loss, and memory loss; asking the elderly and caregivers to summarize the contents of the session; and asking the participants to answer the DASS21. 45 Nurs Midwifery Stud. 2016; 5(1):e28550 3 Ghazavi Z et al. The educational package was based on a thorough literature review and need-assessment interviews of 20 older adults who met the inclusion criteria and their family members but were not recruited in the main study. The package was designed, its content revised, and finally confirmed by 10 faculty members in the Nursing and Midwifery School of the Isfahan University of Medical Sciences. The control group also participated in two group discussion sessions. The participants were asked about their favorite issues, and, consequently, nutrition in aging and exercise in old age were discussed in the first and the second session, respectively. All educational sessions in both groups were facilitated by a geriatric nurse who was unaware of the study objectives and of the groups to which the participants belonged. All subjects in the experimental and the control groups answered the DASS21 three times at the start of the study, at the end of sixth week, and a month after the last educational session of the experimental group. 3.3. Ethical Considerations The study was approved by the research ethics committee of Isfahan University of Medical Sciences. All subjects and their primary caregivers signed a written informed consent before participating in the study. The questionnaires were anonymous, and personal information was kept confidential. The participants were informed of their right to leave the study at any time. The staff of the healthcare centers was informed about the results at the end of the study. The researchers observed all ethical issues in accordance with the Helsinki Declaration. This study is registered at the Iranian registry of clinical trials (registration number 2014110114463N4). 3.4. Data Analysis Data analysis was performed using SPSS version 13 (SPSS Inc., Chicago, IL, USA). Normality of the data was assessed using the Kolmogorov-Smirnov test. Mean (SD) scores were calculated for quantitative variables. Chi-square, Fisher’s exact and t tests were used to compare nominal variables between the two groups.The t-test was also used to compare the difference in mean age, number of family members living together, and number of children between the two groups. Repeated measures ANOVA was also used to compare the statistical difference in the mean depression, anxiety, and stress scores at the three measurement time points and to assess the reciprocal effect of the type of intervention and time on the level of depression and stress. P<0.05 was considered statistically significant for all tests. 4. Results Of the 64 participants in the present study, four were excluded. Two subjects from the experimental group were excluded from analysis because they were absent for more than two sessions. Data of two subjects from the control group were also excluded from the analysis because they did not complete the questionnaire (Figure 1). No significant difference was observed between the demographic characteristics of the two groups of elderly and caregivers (Tables 2 and 3). In repeated measures ANOVA, Mauchly’s test of sphericity was not significant (P=0.852) and repeated measures ANOVA showed no significant difference in the mean depression, anxiety, and stress scores in the control group at the three measurement time points (P > 0.05). Meanwhile, the same test showed a significant difference in the experimental group (P < 0.001; Table 4). Independent samples t-test showed no significant difference in the mean scores of depression, anxiety, and stress between the two groups before intervention (P > 0.05); however, this difference was significant immediately after and 1 month after intervention (P < 0.05). Assessed for Eligibility (n = 155) Randomized (n = 64) Allocated to Control Group (n = 32) Lost to Follow Up (n = 2) Analyzed (n = 30) Excluded (n = 91): Not Meeting Inclusion Criteria (n = 42) Declined to Participate (n = 30) Other Reasons (n = 19) Allocated to Experimental Group (n = 32) Lost to Follow Up (n = 2) Analyzed (n = 30) Figure 1. Consort Flow Diagram of the Study 4 Nurs Midwifery Stud. 2016; 5(1):e28550 Ghazavi Z et al. Table 2. Demographic Characteristics of the Older Adults in the Two Groupsa Variables Gender Female Male Marital status Married Widow Education level Experimental Group 27 (90) Control 28 (93.3) 3 (10) 2 (6.7) 22 (73.3) 21 (70) 8 (26.7) 9 (30) Reading and writing 16 (53.3) 20 (66.7) Diploma 5 (16.7) 4 (13.3) Middle school Financial status Poor Average Good Rich Age, y Number of family members living together Number of children aData are presented as No. (%) or mean ± SD. bFisher’s exact test. cChi-square test. dIndependent t-test. 9 (30) Gender Female Male Marital status 2 (6.7) 1 (3.3) 9 (30) 1 (3.3) 1 (3.3) 64.93 ± 3.82 0.94d 4.36 ± 1.65 4.90 ± 2.09 0.27d 3.13 ± 1.10 Experimental 24 (80) 6 (20) 2.76 ± 0.93 Group Control 25 (83.3) 5 (16.7) Widow 2 (6.7) 3 (10) Secondary level 15 (50) 3 (10) 1 (3.3) 3 (10) 7 (23.3) Bachelor 13 (43.3) 11 (36.7) M …Discussion: Effects of family oriented communications skills Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10 Order NowjQuery(document).ready(function($) { $.post('https://nursingpaperessays.com/wp-admin/admin-ajax.php', {action: 'wpt_view_count', id: '8877'});});jQuery(document).ready(function($) { $.post('https://nursingpaperessays.com/wp-admin/admin-ajax.php', {action: 'mts_view_count', id: '8877'});});

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