ESCALA APGAR FAMILIAR SMILKSTEIN PDF
Apgar Familiar Historia En el Dr Gabriel Smilkstein ¿Qué es el Apgar Familiar? Es un cuestionario de 5 preguntas ¿Para que sirve?. % em ansiedade. depressão e APGAR familiar. respectivamente. . Family Apgar: it is an instrument designed by Gabriel Smilkstein, neurologist, in .. Validación de la escala de Zung para depresión en universitarias de. 6 jan. J.C. Gil de MoraisValidade da prova “Apgar familiar” Revista Portuguesa de Clínica Geral. Lisboa (32) R. Paixão, R. OliveiraA Escala instrumental e expressiva do suporte social Smilkstein, Smilkstein, G. ().
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Fortaleza – CE, Brazil.
The aim of the research was to analyze the psychometric properties of Family APGAR, in a sample of elders in the municipality of Fortaleza, Brazil. The reliability was tested through Cronbach’s alpha, the constructed validity was confirmed with an exploratory factorial analysis Varimax rotationand the validity of criterion was seen in the correlation between Family APGAR and the defining characteristics of the nursing diagnoses of “Discontinue family processes”.
The results demonstrated a Cronbach’s alpha value of 0. The value of Cronbach’s alpha had a different result when one of the items was suppressed, varying from 0.
The factorial analysis demonstrated a single factorization nature of the instrument used in the research. The validity of the criterion showed a coefficient of correlation of 0.
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However, to implement such interventions, it is suggested a simultaneous use of instruments that gather all dimensions to evaluate family functionality. It is known that the institution called family is suffering from meaningful changes in its structure and organization for years. These changes are related to the insertion of women into the labor market, the progressive reduction of fertility rate, the control of birth rate, and the changes seen in social, esala, economical and political spheres 1.
It is perceived that the tendency will lead to confirm that traditional families become even more nuclear, with a frequent coexistence of multi-generational settings, which means children and teenagers may pose higher demands and place potential interferences to support the elderly 12.
For the elders, family is reported as the main responsible to support their social and health demands 12. Hence, to know the dynamics in how the family system works is an essential part in elderly care, over the many different scenarios of professional care. In other words, to know how the family functionality finds a way to fulfill and harmonize its essential roles in an appropriate manner, respecting the identity and the tendencies of its members, in order to work in a realist format to deal with the dangers and the opportunities that are seen in the social environment 3.
Therefore, functional family systems are a therapeutic resource for the person that is aging 2. Then, injuries in family functionality can significantly interfere over smilkkstein demands of elder’s health, with harmful effects over the person’s independence, autonomy and quality of life 45.
To evaluate family functionality, Smilkstein developed the instrument called Family APGAR, which acronym comes from the following domains: Adaptation, which involves the offered family resources when assistance is necessary; Partnership, regarding the reciprocity in family communications and problem solving; Growth, related to the availability of the family to the changes of roles and emotional development; Affection, which includes intimacy and emotional interactions in family context; and Resolve, associated to the decision, determination or resoluteness in a certain family unit 67.
Family APGAR proposes an evaluation of family functionality that is independent of the stage of life of the members smilkstin this same family. Literature demonstrates that it has been used with families with children, teenagers and elders 58 – In Brazil, it has been used in clinical practice in public smilketein service, specially in Family Health Strategy programs, once it is mentioned as a facilitating instrument of observation and analysis of family units, the main focus of intervention of this model of Basic Health Care.
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The use of this instrument enables the detection of dysfunctions in the family system, permitting the generation of interventions aimed to reestablish the balance of the relationships within this system 2.
Family APGAR is recognized by the Brazilian Ministry of Health to evaluate the functionality of families with elders, as part of the Basic Care Guidelines number 19 “Aging and the health of the elderly”, in which is described its usage in interviews with elders’ relatives 2. The instrument was translated, had a transcultural adaptation and a psychometric analysis done with elders living famkliar a municipality located in the Southeast region of Brazil 8.
According to the recommendation for gerontology care 2it is common that, in Brazil, the scientific research use, for the evaluation of functionality of families with elders, the Family APGAR To know the functionality of families with elders from the perception of the elder himself is a relevant issue, as it permits to visualize the value this individual gives to his most elemental source of psychosocial support, permitting to evaluate in which level is the family capable to satisfactorily attend the elder’s caring demands 25 Furthermore, it is seen that familliar the use of Family APGAR by Brazilian researchers, by journals in general, were aimed to classify family functionality 45 A bibliographical research performed in an electronic database, which has scientific articles from many countries in Latin America and in the Caribbean, showed that only one Brazilian study performed in the Southeast region of Brazil demonstrated apagr evaluation of the psychometric proprieties of Family APGAR, but on the other hand, it is not recognized that the results were also published in an article 8.
Investigations that proposed a psychometric analysis of the qualitative measurement instruments are important, once their reliability and validation are essential aspects to estimate the scientific quality of standardized instruments 13 The lack of validation studies is a disturbing fact, once the clinical decision making process must be based on the use of criteria and instruments that are clearly adequate to be consumed by specific groups, because there are sociocultural particularities present among different population segments and geographic scenarios, thus not enabling great generalizations of the results of adequacy of certain procedures.
Only after the verification that an instrument has satisfactory psychometric characteristics within a certain context of application it can guarantee that its usage is appropriate 13 The evidence of adequate parameters of reliability and validity of Family APGAR used with elders residing in the Northeastern region of Brazil will ensure that the use of such tool is adequate famipiar evaluate family functionality with elders in many cities of this region.
Likewise, this will also provide a higher level of safety regarding the professional interventions aimed to the families, based on the information gathered with this instrument. Despite being validated in a state of a distinct geographical region 8another new situation of administration requires a new psychometric analysis, as an instrument is not validated by its measurement, but by its application Furthermore, a new validation of this instrument over a specific group will help the scientific research in gerontology.
This is a methodological research, that deals with the development, validation and evaluation of research tools They were visited, as well as the residence of the users of the Centers located up to nine blocks away from it, in a clockwise direction, to identify the homes of the elders.
In the sample, all elders that were autonomous, with functional communication and cognitive capacity -indifferently from the level of functional independence, and that freely adhere to this study, were added.
The participants were explained about the objectives of the study. The elders that lived alone were excluded from the research. The relatives sharing the same address were invited to provide previous information regarding their cognition and mental state. The ones responsible to collect the data were previously trained to apply the research instruments. Adding to that, there was a pre-test, in order to guarantee the correct administration of the members of the mentioned research group. The instruments used were: This last instrument was specifically developed by the authors of this study to facilitate the analysis to validate the criteria of Family APGAR.
Closed questions were generated, in order to deal with every defining characteristic of the nursing diagnose mentioned. This instrument was selected because it contemplates the characteristics present in all dimensions involved in the concept of family functionality. The definition of the nursing diagnose “Discontinued family processes” is similar to the characterization of family dysfunction 6 According to the content, each one of the 18 defining characteristics of the nursing diagnose was associated to one of the domains of the Family APGAR adaptation, partnership, growth, affection or resolve.
Two open questions were designed to contemplate each defining characteristic. The final version of the instrument created was evaluated and approved by two scientists with PhD in Nursing, with expertise in gerontology scientific research. The scores needed to analyze the correlation using Pearson’s r coefficient between the instrument created and Family APGAR were acquired from the calculation of the average of the scores found.
Considering a set of 36 questions, equivalent to the 18 defining characteristics, the total score could vary from 0 to 72 points, generating the following classification regarding family functionality: To determine the reliability of Family APGAR, the method of Cronbach’s alpha was used, through the coefficient of discrimination of the items, considering as a satisfactory result if values were above 0.
The cutting point of the value of Cronbach’s alpha in compressed items was 0. The technique of “Hotelling’s t-square” was also applied, which tests the blank hypothesis that all averages from all items are the same. To analyze the validity of the construct, there was an exploratory factorial analysis, using the technique of analysis of main components, with the orthogonal Varimax rotation.
In the process of determination of the number of factors, the criterion of eigenvalues higher than one was used. Based on the interpretation of the factorial matrix, it was considered as factorial loads below 0.
Analysis of psychometric properties of family APGAR with elderly in northeast Brazil
The KMO result was 0. In the analysis of criterion validity, there was the calculation of the correlation between the Family APGAR scores and the scores achieved in the instrument designed to evaluate the defining characteristics of the nursing diagnose “Discontinued family processes”. In order to do so, the Pearson’s r familiaf coefficient was used. Because of that, it was considered an adequate criterion, which was also the reason why it was taken, in this study, as the benchmark, once it was used and validated diagnose by NANDA International 613 The participants were informed about the goals of the study; eventual questions about the esscala were answered, and it was guaranteed the right to anonymity and confidentiality of data.
Furthermore, all signed the Statement of Informed Consent. The socio-demographic characteristics of the elders that composed the sample showed that: The majority of the elders In regards to the component members of their family, The average amount of relatives was 3. When they were asked about the quality of the relationship with their relatives, The family bonds demonstrated that As a consequence, there was no agglutination of answers in one single category.
According to the demonstration in Table 1it was seen apgad the discrimination coefficient oscillated between 0. The factor identified is the offered family support to the elder Table 2. To understand the functionality of families with elders is an essential component to a successful planning of health interventions, specially in Primary Care, fajiliar the relevance of the usage of escaal Family APGAR instrument in gerontology care as tool to facilitate healthcare procedures 25 It is important to highlight the use of Family APGAR recommended by the Brazilian Ministry of Health in the country 2thus supposing it is already adequate regarding semantic, conceptual, operational and item-wise equivalence Furthermore, despite being transculturally adapted with a sample from the Southeast region of Brazil 8Family APGAR has only five evaluation items, described by short sentences, easy to comprehend, without regional expressions, and with simple and clear answering options, allowing to support the adequacy of the instrument, as well as to be used with samples from other parts of the country.
In regards to the application of the instrument in elders, as seen in the context of the smil,stein municipality of the Familiarr region of Apgae, the reliability results, evaluated by its internal consistency using Cronbach’s alpha demonstrated scores neat to one, thus being categorized as a reliable element Another positive aspect to be considered was that both the alpha score in a total scale 0.
In the analysis of the behavior of each item, in regards to the contribution to smi,kstein internal consistency of the instrument, it was seen a small variation from 0. In regards to the exploratory factorial analysis of the Family APGAR used with the elderly residing in the Northeast region of Brazil, after the extraction of the factors apgra rotation of the matrix of initial solution, to the orthogonal Varimax rotation, the results demonstrated that the scale was unifactorial, analogue to the results of the original validation study, as well as in the investigation that the psychometric analysis performed with Colombian young students 7 The domains “adaptation”, “growth”, “affection” and “resolve” were not identified as factors in the matrix of correlations of exploratory factorial analysis, thus leading to believe that during the use of Family APGAR, specifically among elder respondents of Brazilian Northeast region, other elements of evaluation smilkatein the family functionality construct familiaf “partnership” were not properly contemplated by the mentioned instrument.
Therefore, with this specific public there was the confirmation that the instrument must be used only for screening, to estimate family functionality, as it does not allow a complete evaluation of the construct. This reinforces the idea that when using Family APGAR, it is necessary the support of other instruments, or even other types of professional evaluation to justify and implement effective interventions related to the dynamics of family functioning in a clinical context 67 The analysis of the validity of Family APGAR criterion, in this study, demonstrated to be satisfactory, which can be seen by the Pearson’s r correlation coefficient found: This results permits to affirm smilketein Family APGAR classified as a dysfunctional family total results between zero and six points the elders that also achieved family dysfunctionality under the defining characteristics of the nursing diagnose “Discontinued family processes” results between zero and 45 points generated after the application of the instrument specifically designed for this evaluation In regards to the limitations and innovations generated in this study, it is important to emphasize that the performance of interviews at the homes of the elders adduced advantages because it enabled higher proximity with the interviewees, as well as the participation of a edcala number of elders with different family characteristics; and disadvantages, once the presence of other family members during interviews may have possibly influenced the type of answer given to the interviewers.
This practice should be considered favorable, as it allowed to visualize the psychometric performance of the instrument in different circumstances found in other studies 710 Despite the restrictions found in the analysis of the validity of the contruct, it is possible to state that Family APGAR, when used in elders in the Brazilian Northeast region, is an adequate instrument sscala evaluate family functionality, as it gathers satisfactory requirements of internal consistency and validity of criterion, which gives it a characteristic of a screening instrument appropriate to the necessary estimate.
However, for a wider intervention planning, it is suggested that other measuring instruments are used simultaneously, in order that the evaluation of all dimensions of family functioning are observed properly. There is a recommendation to continue the process of validation of the instrument with the elderly, tamiliar when dealing with its validity in the construct. Further analysis of the factorial structure can clarify how the instrument in fact, evaluates the family functionality construct.
There is a strong suggestion to perform future investigations that may evaluate the psychometric proprieties of Family APGAR, not only over the regional scenario of Brazilian Northeast region, but also in many other sociocultural environments of the different geographical regions of the country. This approach will enable satisfactory comparison and discussion of the results found by other studies of analysis of reliability parameters and validity of instrument, reinforcing the relevance of its usage in gerontology practice.
Effectiveness of an intervention in groups of family caregivers of dependent patientsfor their application in primary health centers. Qualidade fsmiliar vida e fatores associados em idosos dependentes em uma cidade do interior do Nordeste.
Fundamentos de pesquisa em Enfermagem: What is coefficient alpha?
An examination of theory and applications.