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Che RP, Cheung MC. Factors Associated with the Utilization of Home and Community-Based Services (HCBS) Among Older Adults: A Systematic Review of the Last Decade. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:776-802. [PMID: 38616618 DOI: 10.1080/01634372.2024.2342455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/09/2024] [Indexed: 04/16/2024]
Abstract
Home and community-based services (HCBS) for older adults have been promoted worldwide to address the growing problems of aging. This systematic review included 59 studies published from 2013 to 2023 to explore factors influencing the utilization of HCBS among older adults. The review identified 15 common factors grouped into four levels of influence: individual, inter-relationship, community, and social contextual levels. The findings suggest that HCBS utilization is a dynamic process influenced by multiple factors at different levels. Gerontological social work should incorporate ecological thinking to improve practice and strengthen caregiver-recipient relationships.
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Affiliation(s)
- Run-Ping Che
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mei-Chun Cheung
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, China
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Brady S, Patskanick T, Coughlin JF. An Intersectional Approach to Understanding the Psychological Health Effects of Combining Work and Parental Caregiving. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae042. [PMID: 38518119 DOI: 10.1093/geronb/gbae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVES Role theory suggests occupying simultaneous family caregiving and employment roles in midlife may exert positive and negative effects on psychological health. However, there is a lack of causal evidence examining the degree to which combinations of these roles influence psychological health at the intersection of gender and racial identity. METHODS Longitudinal data from the Health and Retirement Study (2004-2018) are used to estimate a series of individual fixed effects models examining combinations of employment status and parental caregiving situation on Center for Epidemiological Studies-Depression Scale (CES-D) depression scores among Black and White men and women aged 50-65. Subsequent models were stratified by intensity of caregiving situation and work schedule. RESULTS Individual fixed effects models demonstrate combining work, and parental caregiving is associated with greater depressive symptoms than only working, and with lower depressive symptoms than only caregiving, suggesting that paid employment exerts a protective effect on psychological health whereas parental caregiving may be a risk factor for depressive symptoms in later life. Analyses using an intersectional lens found that combining paid work with parental caregiving exerted a protective effect on CES-D scores among White women and men regardless of participants' intensity of care situation or work schedule. This effect was not present for Black men and women. DISCUSSION Accounting for intersectionality is imperative to research on family caregiving, work, and psychological health.
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Affiliation(s)
- Samantha Brady
- MIT AgeLab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Department of Sociology, Brown University, Providence, Rhode Island, USA
| | - Taylor Patskanick
- MIT AgeLab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Joseph F Coughlin
- MIT AgeLab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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Billig M, Maor M. From the body as an object to embodied subjectivity: Social egg freezing as a personal definition rite among ultra-orthodox singles. Soc Sci Med 2024; 348:116810. [PMID: 38547810 DOI: 10.1016/j.socscimed.2024.116810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/04/2024] [Accepted: 03/19/2024] [Indexed: 04/29/2024]
Abstract
As an innovative reproductive technology, social egg freezing (SEF) challenges the ultra-Orthodox community's position in the tension between tradition and modernity. On the one hand, SEF can enable singles of advanced age to fulfill their most important social and religious role of building big families when they eventually marry. On the other hand, exposure to SEF may lead to openness to social change, including changes in gender roles, division of labor, and control over female fertility. Based on in-depth interviews, the present study examined the experiences of ultra-Orthodox singles throughout the SEF process, based on conceptual frameworks of "rites of passage", "group definition ceremonies" and "personal definition rites". The findings reveal that ultra-Orthodox single women creatively invented strategies to discreetly cope with various obstacles, unassisted by their families or communities. Not only can personal definition rites take form without the community's participation and support, but they can also be carried out privately and secretively. By undergoing SEF, ultra-Orthodox singles exert agency in making independent choices over their bodies. Despite being embedded in a conservative, traditional context, the results indicate that participants initiate bottom-up change in social norms in relation to the status of singlehood, timing of marriage, and family size.
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Affiliation(s)
- Miriam Billig
- Department of Sociology & Anthropology, Ariel University, Israel.
| | - Maya Maor
- Department of Sociology & Anthropology, Ariel University, Israel.
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Brady S. New Role, New Paycheck: The Impact on Women's Wages When Becoming a Caregiver for an Aging Parent. Res Aging 2024; 46:197-209. [PMID: 37977132 DOI: 10.1177/01640275231217297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Objectives: While prior research demonstrates the negative impacts of adult caregiving on women's employment, less research examines how women's employment changes when beginning a new caregiving role. Methods: Using data from eight waves of the Health and Retirement Study (2004-2018), I examine changes in women's employment when first transitioning into parental caregiving between the ages of 50-60, by analyzing changes in labor force participation, work hours, and hourly wages. Results: The transition into parental caregiving was not associated with women exiting the workforce or decreasing their work hours. However, caregivers did experience a decrease in inflation-adjusted hourly wages compared to non-caregivers, with the greatest wage penalties associated with high-intensity caregiving situations. Conclusion: Results demonstrate how parental caregiving may act as a shock to women's financial health at a critical career stage. This study highlights the less visible, but detrimental, financial consequences women experience when taking on a family caregiving role.
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Affiliation(s)
- Samantha Brady
- Department of Sociology, Brown University, Providence, RI, USA
- AgeLab, Massachusetts Institute of Technology, Cambridge, MA, USA
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5
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Webb K, Sharpe L, Russell H, Shaw J. Fear of cancer recurrence in ovarian cancer caregivers: A qualitative study. Psychooncology 2024; 33:e6255. [PMID: 38047732 DOI: 10.1002/pon.6255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/18/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023]
Abstract
AIM Although there is growing research exploring survivor fear of cancer recurrence (FCR), little is known about caregiver FCR. To date, examination of caregiver FCR has largely been conducted through the lens of survivor conceptualisations, limiting the development of caregiver-specific models, measures, and interventions. This study aimed to explore experiences of FCR among caregivers of people with ovarian cancer. METHODS Semi-structured telephone interviews were conducted with caregivers of people with ovarian cancer. Participants, recruited through Ovarian Cancer Australia, also completed an online survey collecting participant and patient demographic characteristics, information about the survivor's disease and caregiver levels of FCR using the Fear of Cancer Recurrence Inventory (Caregiver) (FCRI-c). Qualitative interviews explored caregiver fears, how fears and concerns were experienced and the frequency and timing of FCR. Thematic analysis using a Framework Approach was used to analyse the results. RESULTS Twenty-four caregivers (54% male) participated in an interview. Most caregivers were providing care for their partner (n = 14). Thematic analysis identified four inter-related themes and associated sub-themes: (1) Fear and uncertainty; (2) Liminality; (3) Hopelessness and (4) Caregiver's protection of the person and self (caregiver's role as protector). Underpinning these themes was an overarching fear of one's family member dying. CONCLUSIONS Caregivers supporting people with ovarian cancer experience worries and concerns related to cancer recurrence or progression. These experiences are conceptually different to survivor experiences. Fear of one's family member dying, and the dual nature of caregiver protection/self-protection mean it is imperative that interventions are tailored specifically to caregiver needs. Future research facilitating the development of appropriate measures and interventions is essential to reduce caregiver FCR.
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Affiliation(s)
- Kyra Webb
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- The Psycho-Oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Hayley Russell
- Ovarian Cancer Australia, Melbourne, Victoria, Australia
| | - Joanne Shaw
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- The Psycho-Oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
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Jain U, Sheehan CM. Comparative Analysis of Gender and Age Patterns in Informal Care Received among Disabled Older Adults: A Cross-National Study across the United States, Mexico, China, and Indonesia. J Cross Cult Gerontol 2023; 38:389-415. [PMID: 37725209 DOI: 10.1007/s10823-023-09488-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/21/2023]
Abstract
This paper examines cross-national differences by gender and age in receipt and sources of help for limitations with activities of daily living or instrumental activities of daily living among older adults in the United States, Mexico, China, and Indonesia. Respondents aged 50 + from the Health and Retirement Study, Mexican Health and Aging Study, China Health and Retirement Longitudinal Study, and Indonesia Family Life Survey are included. Descriptive methods, logistic and multinomial regression analyses are used to examine patterns in any help received and main source of help respectively. After controlling for age, marital status, and co-residence with child(ren), it is found that men in all four countries overwhelmingly relied on their spouse for care, while children are more likely to be the main source of care for women. Children as the main source of care increased with age in each country and among men and women, surpassing spouse in China and Indonesia, and to a lesser extent in Mexico, but not in the United States where spouse was found to be more likely to be main caregiver even among the oldest age groups. Caregiving for the disabled is important for the well-being of the care recipient and for caregivers. Our results shed light on the asymmetric burden of caregiving on female spouses, across four diverse and aging countries.
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Affiliation(s)
- Urvashi Jain
- Department of Economics, Finance, and Real Estate, Mitchell College of Business, University of South Alabama, 5811 USA S Dr, MCOB 310, Mobile, AL, USA.
| | - Connor M Sheehan
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
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Culberson JW, Kopel J, Sehar U, Reddy PH. Urgent needs of caregiving in ageing populations with Alzheimer's disease and other chronic conditions: Support our loved ones. Ageing Res Rev 2023; 90:102001. [PMID: 37414157 PMCID: PMC10756323 DOI: 10.1016/j.arr.2023.102001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
The ageing process begins at birth. It is a life-long process, and its exact origins are still unknown. Several hypotheses attempt to describe the normal ageing process, including hormonal imbalance, formation of reactive oxygen species, DNA methylation & DNA damage accumulation, loss of proteostasis, epigenetic alterations, mitochondrial dysfunction, senescence, inflammation, and stem cell depletion. With increased lifespan in elderly individuals, the prevalence of age-related diseases including, cancer, diabetes, obesity, hypertension, Alzheimer's, Alzheimer's disease and related dementias, Parkinson's, and other mental illnesses are increased. These increased age-related illnesses, put tremendous pressure & burden on caregivers, family members, and friends who are living with patients with age-related diseases. As medical needs evolve, the caregiver is expected to experience an increase in duties and challenges, which may result in stress on themselves, and impact their own family life. In the current article, we assess the biological mechanisms of ageing and its effect on body systems, exploring lifestyle and ageing, with a specific focus on age-related disorders. We also discussed the history of caregiving and specific challenges faced by caregivers in the presence of multiple comorbidities. We also assessed innovative approaches to funding caregiving, and efforts to improve the medical system to better organize chronic care efforts, while improving the skill and efficiency of both informal and formal caregivers. We also discussed the role of caregiving in end-of-life care. Our critical analysis strongly suggests that there is an urgent need for caregiving in aged populations and support from local, state, and federal agencies.
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Affiliation(s)
- John W Culberson
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jonathan Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, 1301 Akron Ave, Lubbock, TX 79409, USA; Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Public Health Department of Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.
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Stenner P, De Luca Picione R. A Theoretically Informed Critical Review of Research Applying the Concept of Liminality to Understand Experiences with Cancer: Implications for a New Oncological Agenda in Health Psychology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5982. [PMID: 37297586 PMCID: PMC10253067 DOI: 10.3390/ijerph20115982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
Liminality was described more than 20 years ago as a major category explaining how cancer is experienced. Since then, it has been widely used in the field of oncology research, particularly by those using qualitative methods to study patient experience. This body of work has great potential to illuminate the subjective dimensions of life and death with cancer. However, the review also reveals a tendency for sporadic and opportunistic applications of the concept of liminality. Rather than being developed in a systematic way, liminality theory is being recurrently 're-discovered' in relatively isolated studies, mostly within the realm of qualitative studies of 'patient experience'. This limits the capacity of this approach to influence oncological theory and practice. In providing a theoretically informed critical review of liminality literature in the field of oncology, this paper proposes ways of systematizing liminality research in line with a processual ontology. In so doing, it argues for a closer engagement with the source theory and data, and with more recent liminality theory, and it sketches the broad epistemological consequences and applications.
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Affiliation(s)
- Paul Stenner
- School of Psychology and Counselling, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK;
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Marlow M, Skeen S, Hunt X, Sundin P, Weiss RE, Mofokeng S, Makhetha M, Cluver L, Sherr L, Tomlinson M. Depression, anxiety, and psychological distress among caregivers of young children in rural Lesotho: Associations with food insecurity, household death and parenting stress. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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10
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Loveday M, Hlangu S, Larkan LM, Cox H, Daniels J, Mohr-Holland E, Furin J. "This is not my body": Therapeutic experiences and post-treatment health of people with rifampicin-resistant tuberculosis. PLoS One 2021; 16:e0251482. [PMID: 34662887 PMCID: PMC8523213 DOI: 10.1371/journal.pone.0251482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/27/2021] [Indexed: 11/19/2022] Open
Abstract
Background There are few data on the on post-treatment experiences of people who have been successfully treated for rifampicin-resistant (RR-)TB. Objective To describe the experiences and impact of RR-TB disease and therapy on post-treatment life of individuals who were successfully treated. Methods In this qualitative study in-depth interviews were conducted among a purposively selected sample from a population of individuals who were successfully treated for RR-TB between January 2008 and December 2018. Interview transcripts and notes were analysed using a thematic network analysis which included grounded theory and a framework for understanding pathophysiological mechanisms for post-TB morbidity and mortality. The analysis was iterative and the coding system developed focused on disease, treatment and post-treatment experiences of individuals. This paper follows the COREQ guidelines. Results For all 12 participants interviewed, the development of RR-TB disease, its diagnosis and the subsequent treatment were a major disruption to their lives as well as a transformative experience. On diagnosis of RR-TB disease, participants entered a liminal period in which their lives were marked with uncertainty and dominated by physical and mental suffering. Irrespective of how long ago they had completed their treatment, they all remembered with clarity the signs and symptoms of the disease and the arduous treatment journey. Post-treatment participants reported physical, social, psychological and economic changes as consequences of their RR-TB disease and treatment. Many participants reported a diminished ability to perform physical activities and, once discharged from the RR-TB hospital, inadequate physical rehabilitation. For some, these physical limitations impacted on their social life, and ultimately on their psychological health as well as on their ability to earn money and support their families. Conclusion The experiences and impact of RR-TB disease and therapy on post-treatment life of individuals successfully treated, highlights gaps in the current health care system that need to be addressed to improve the life of individuals post-treatment. A more holistic and long-term view of post-TB health, including the provision of comprehensive medical and social services for post-treatment care of physical ailments, social re-integration and the mitigation of the perceived fear and risk of getting TB again could be a central part of person-centred TB care.
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Affiliation(s)
- Marian Loveday
- HIV Prevention Research Unit, South African Medical Research Council, KwaZulu-Natal, South Africa
- CAPRISA-MRC HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Sindisiwe Hlangu
- HIV Prevention Research Unit, South African Medical Research Council, KwaZulu-Natal, South Africa
| | - Lee-Megan Larkan
- Greytown Specialised TB Hospital, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
| | - Helen Cox
- Institute for Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Disease Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Johnny Daniels
- Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa
| | | | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
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At the Heart of It All: Emotions of Consequence for the Conceptualization of Caregiver-Reported Outcomes in the Context of Colorectal Cancer. ACTA ACUST UNITED AC 2021; 28:4184-4202. [PMID: 34677273 PMCID: PMC8534905 DOI: 10.3390/curroncol28050355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022]
Abstract
Colorectal cancer (CRC) can be demanding for primary caregivers; yet, there is insufficient evidence describing the caregiver-reported outcomes (CROs) that matter most to caregivers. CROs refer to caregivers' assessments of their own health status as a result of supporting a patient. The study purpose was to describe the emotions that were most impactful to caregivers of patients with CRC, and how the importance caregivers attribute to these emotions changed from diagnosis throughout treatment. Guided by qualitative Interpretive Description, we analyzed 25 caregiver and 37 CRC patient interviews, either as individuals or as caregiver-patient dyads (six interviews), using inductive coding and constant comparative techniques. We found that the emotional aspect of caring for a patient with CRC was at the heart of caregiving. Caregiver experiences that engendered emotions of consequence included: (1) facing the patient's life-changing diagnosis and an uncertain future, (2) needing to be with the patient throughout the never-ending nightmare of treatment, (3) bearing witness to patient suffering, (4) being worn down by unrelenting caregiver responsibilities, (5) navigating their relationship, and (6) enduring unwanted change. The broad range of emotions important to caregivers contributes to comprehensive foundational evidence for future conceptualization and the use of CROs.
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Ross A, Jumin Lee L, Wehrlen L, Cox R, Yang L, Perez A, Bevans M, Ding A, Wallen G. Factors That Influence Health-Promoting Behaviors in Cancer Caregivers. Oncol Nurs Forum 2021; 47:692-702. [PMID: 33063787 DOI: 10.1188/20.onf.692-702] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe cancer caregivers' participation in health-promoting behaviors and to identify factors influencing participation. SAMPLE & SETTING 129 informal cancer caregivers at the National Institutes of Health Clinical Center. METHODS & VARIABLES Cross-sectional survey methodology using Health-Promoting Lifestyle Profile-II (HPLP-II), PROMIS® Global Physical Health, NIH Toolbox Stress and Self-Efficacy, Caregiver Reaction Assessment, and Family Care Inventory Mutuality subscale. RESULTS Caregivers reported the highest HPLP-II subscale scores for spirituality and interpersonal relationships and the lowest for physical activity. Caregivers who were older, with lower body mass indices, in better physical health, and with higher self-efficacy and mutuality participated in more health-promoting behaviors. Sixty percent of the caregivers reported that they exercised less since becoming a caregiver, and 47% reported that their diet was worse. IMPLICATIONS FOR NURSING Future research is needed to examine novel interventions to increase health-promoting activities in cancer caregivers, and these interventions might be strengthened by including components that focus on increasing self-efficacy and/or improving the strength of the relationship between the caregiver and care recipient.
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Affiliation(s)
- Alyson Ross
- National Institutes of Health Clinical Center
| | | | | | - Robert Cox
- National Institutes of Health Clinical Center
| | - Li Yang
- National Institutes of Health Clinical Center
| | - Avery Perez
- Philadelphia College of Osteopathic Medicine
| | | | - Alice Ding
- National Institutes of Health Clinical Center
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13
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Experiences of family caregivers of patients with COVID-19. BMC FAMILY PRACTICE 2021; 22:137. [PMID: 34187368 PMCID: PMC8241402 DOI: 10.1186/s12875-021-01489-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/10/2021] [Indexed: 12/23/2022]
Abstract
Background Family caregivers of patients with COVID-19 face many challenges that affect their physical and mental health. Aim The aim of the present study was to explore experiences of family caregivers of patients with COVID-19. Methods This phenomenological study was performed based on 13 family caregivers who had experience in home caring for patients with COVID-19. Data were collected through purposive sampling with in-depth semi-structured interviews. The Colaizzi's 7-step method was used to determine themes. The MAXQDA10 software was used to manage qualitative data analysis. Results Thirteen family caregivers participated. Five main themes describe family caregivers' experiences of caring for patients with COVID-19: nature of the disease; unmet needs; unpleasant physical, psychological, and social experiences; care facilitators and positive experiences. Conclusion Information and financial support for COVID-19 should be provided to family caregivers. Also, community members should embrace patients and family caregivers and reinforce the positive experiences of caregivers. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01489-7.
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Thilo FJ, Hahn S, Halfens RJ, Heckemann B, Schols JM. Facilitating the use of personal safety alerting device with older adults: The views, experiences and roles of relatives and health care professionals. Geriatr Nurs 2021; 42:935-942. [PMID: 34130125 DOI: 10.1016/j.gerinurse.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022]
Abstract
To explore relatives', community nurses' and general practitioners' perspectives and experiences in promoting Personal Safety Alerting Device (PSAD) use among community-dwelling older adults, we applied a qualitative study design. Altogether 15 focus groups and 11 semi-structured interviews were conducted. Data-analysis followed the Qualitative Analysis Guide of Leuven. PSAD use was considered to be complex. Relatives and health care professionals are involved in a negotiation process comprising three phases: A) waiting for a critical event in the older adult's everyday life; B) introducing the idea of a PSAD; C) deciding on and supporting PSAD use. In conclusion, the actors involved in PSAD use should be aware of the negotiation process, which is complex, dynamic, iterative and needs time. While nurses play a crucial role, they lack sufficient knowledge for comprehensive PSAD counselling. The negotiation process could serve as an example for other technologies in the context of aging in place.
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Affiliation(s)
- Friederike Js Thilo
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
| | - Sabine Hahn
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
| | - Ruud Jg Halfens
- School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Birgit Heckemann
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Anaesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Jos Mga Schols
- School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands; School CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.
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Ailshire J, Osuna M, Wilkens J, Lee J. Family Caregiving and Place of Death: Insights From Cross-national Analysis of the Harmonized End-of-Life Data. J Gerontol B Psychol Sci Soc Sci 2021; 76:S76-S85. [PMID: 33378449 DOI: 10.1093/geronb/gbaa225] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Family is largely overlooked in research on factors associated with place of death among older adults. We determine if family caregiving at the end of life is associated with place of death in the United States and Europe. METHOD We use the Harmonized End of Life data sets developed by the Gateway to Global Aging Data for the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Health and Retirement Study (HRS). We conducted multinomial logistic regression on 7,113 decedents from 18 European countries and 3,031 decedents from the United States to determine if family caregiving, defined based on assistance with activities of daily living, was associated with death at home versus at a hospital or nursing home. RESULTS Family caregiving was associated with reduced odds of dying in a hospital and nursing home, relative to dying at home in both the United States and Europe. Care from a spouse/partner or child/grandchild was both more common and more strongly associated with place of death than care from other relatives. Associations between family caregiving and place of death were generally consistent across European welfare regimes. DISCUSSION This cross-national examination of family caregiving indicates that family-based support is universally important in determining where older adults die. In both the United States and in Europe, most care provided during a long-term illness or disability is provided by family caregivers, and it is clear families exert tremendous influence on place of death.
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Affiliation(s)
- Jennifer Ailshire
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, US
| | - Margarita Osuna
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, US
| | - Jenny Wilkens
- Center for Economic and Social Research (CESR), University of Southern California, Los Angeles, US
| | - Jinkook Lee
- Center for Economic and Social Research (CESR), University of Southern California, Los Angeles, US
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16
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Mau M, Nielsen DS, Jakobsen IS, Klausen SH, Roessler KK. Mental movements: How long-distance walking influences reflection processes among middle-age and older adults. Scand J Psychol 2021; 62:365-373. [PMID: 33719040 DOI: 10.1111/sjop.12721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/29/2021] [Indexed: 12/20/2022]
Abstract
By providing a distinctive room for reflection, long-distance walks can help people similar to professional counselling. To understand reflection processes' influence on mental health, a framework focusing on personal transformations, specifically through the concept of liminality, can be used. Through nine semi-structured interviews with middle-aged and older long-distance walkers, this study answers the following question: How do middle-aged and older adults experience long-distance walking, and how do their experiences influence their reflective process? Four themes emerged during the analysis: (1) overcoming strain and achieving a sense of capability; (2) simplicity in obligations and having the time to pursue emotionally difficult experiences; (3) solitariness and reflection on oneself; and (4) calmness and embracing thoughts. These findings illustrate how going on long-distance walks may be similar to entering a liminal, or transformational, space. The findings show how long-distance walks can be helpful, or perhaps even therapeutic, in situations where personal transformation is required.
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Affiliation(s)
- Martin Mau
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Health, Social Work and Welfare Research, UCL University College, Odense, Denmark.,Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Dorthe S Nielsen
- Migrant Health Clinic, Odense University Hospital, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Ida Skytte Jakobsen
- Health, Social Work and Welfare Research, UCL University College, Odense, Denmark
| | - Søren H Klausen
- Department for the Study of Culture, University of Southern, Odense, Denmark
| | - Kirsten K Roessler
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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17
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Hagen J, Loa Knizek B, Hjelmeland H. " … I felt completely stranded": liminality and recognition of personhood in the experiences of suicidal women admitted to psychiatric hospital. Int J Qual Stud Health Well-being 2020; 15:1731995. [PMID: 32106793 PMCID: PMC7054963 DOI: 10.1080/17482631.2020.1731995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: The purpose of this study is to explore how patients experience their suicidality and how they experience being in a psychiatric hospital. Methods: This is part of a field study, and the article is based on data collected in interactions with 11 women who were admitted to a psychiatric hospital and were struggling with suicidality. Data were collected through interviews, conversations, and participatory observation. We analysed the data by means of Systematic Text Condensation, followed by a deductive process where the data and preliminary findings were interpreted in light of the theory of liminality. Results: We found that the patients’ experiences of suicidality and being a patient in a psychiatric acute ward involve “Liminality and weakened sense of personhood,” and from their perspective, “Recognition of personhood” is an important aspect of care. Conclusion: Our study indicates that suicidality and psychiatric hospitalization involve liminality and weakened sense of personhood, aspects that are important to consider in the care of the patients. Professionals need to acknowledge more the importance of recognition of personhood in care, since this can strengthen the patient’s self-worth and empower the person. Lack of recognition may increase the patient’s suffering and suicidality.
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Affiliation(s)
- Julia Hagen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Birthe Loa Knizek
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Heidi Hjelmeland
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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18
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Ross A, Perez A, Wehrlen L, Lee LJ, Yang L, Cox R, Bevans M, Ding A, Wiener L, Wallen GR. Factors influencing loneliness in cancer caregivers: A longitudinal study. Psychooncology 2020; 29:1794-1801. [PMID: 32672866 DOI: 10.1002/pon.5477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe levels of loneliness in cancer caregivers over a 6 month time period, and to examine factors that influence changes in loneliness in caregivers over time. METHODS Prospective, repeated measures design was utilized to examine levels of loneliness and factors that influence loneliness in 129 family caregivers of individuals undergoing cancer treatment at three time points over a 6 month period. Measures included: PROMIS global health and sleep disturbance; NIH Toolbox loneliness, self-efficacy and perceived stress; Family Care Inventory mutuality scale; and Caregiver Reaction Assessment. RESULTS Approximately one third (30.2%, n = 39) of the caregivers had high levels of loneliness, and levels of loneliness did not change over the three time points (P = .985). For any given time point, caregivers who were not married (P = .008), not working (P = .027), with worse mental health (P = .015), more perceived-stress (P < .0001), and more caregiver burden (P = .003) reported higher levels of loneliness. CONCLUSION This study provides guidance for clinicians attempting to identify at-risk caregivers by confirming the findings of previous research that caregivers with higher burden, stress and in poor mental health are at increased risk for loneliness. This study provides preliminary evidence that continuing to work during the caregiving trajectory may be beneficial to caregivers by reducing levels of loneliness. Future research is needed to confirm these findings and to examine novel interventions to reduce loneliness in cancer caregivers.
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Affiliation(s)
- Alyson Ross
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Avery Perez
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Leslie Wehrlen
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Lena J Lee
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Li Yang
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Robert Cox
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Margaret Bevans
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Alice Ding
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Lori Wiener
- National Cancer Institute Center for Cancer Research Pediatric Oncology Branch, Bethesda, Maryland, USA
| | - Gwenyth R Wallen
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
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19
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Unson C, Flynn D, Chukwurah Q, Glendon MA, Testut T. Uncertainty in Transition of African American Caregivers. Issues Ment Health Nurs 2020; 41:445-454. [PMID: 32186923 DOI: 10.1080/01612840.2019.1678080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to gain an understanding of the ambiguities and uncertainties experienced by a diverse group of African-American caregivers. The study applied Schlossberg's transition theory (TT) and Mishel's revised uncertainty theory to narratives of self-identified African-American caregivers who provided care at least 5 h a week. The men (6) and women (8) were mostly unmarried, mostly caring for a parent or grandparent. The caregivers' average age was 52 (SD = 19; ages ranged from 24 to 82 years); and the care recipients' average age was 84 (SD = 9). Six care recipients had dementia and the remainder had multiple disease diagnoses. Narratives were obtained by in-depth interviews or focus group discussions. These were audio-recorded, transcribed verbatim professionally and analyzed independently by trained coders. Schlossberg's TT contextualized whereas Mishel's RUIT illuminated the characteristics of the transition, its associated uncertainty, and their relationship to the development of caregiver stress. Situational factors such as difficulties with illness symptoms of the care recipient, conflict between previous experience and current expectations and the adjustments to the new caregiving role, burdened younger caregivers more than older caregivers. Self-factors related to lack of knowledge about the illness and feelings of lack of control. Social support was predominantly provided by family members, and its absence resulted in conflict among siblings and caregiver stress. The most common coping strategies include religiosity, expectations of reciprocity, and coming to terms with the uncertainty. Understanding the feelings, perceptions and needs of caregivers in transition is tantamount to providing nursing care.
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Affiliation(s)
- Christine Unson
- Department of Public Health, Southern Connecticut State University, New Haven, Connecticut, USA
| | - Deborah Flynn
- Department of Public Health, Southern Connecticut State University, New Haven, Connecticut, USA
| | | | - Mary Anne Glendon
- Department of Nursing, Southern Connecticut State University, New Haven, Connecticut, USA
| | - Tammy Testut
- Sacred Heart University, College of Nursing, Fairfield, Connecticut, USA
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20
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Gibbons SW, Ross A, Wehrlen L, Klagholz S, Bevans M. Enhancing the cancer caregiving experience: Building resilience through role adjustment and mutuality. Eur J Oncol Nurs 2019; 43:101663. [PMID: 31606005 DOI: 10.1016/j.ejon.2019.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 08/30/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to explore the dyadic experience of caring for a family member with cancer. Particular attention was given to examine the relationship between dyadic perceptions of role adjustment and mutuality as facilitators in resilience for posttreatment cancer patients and family caregivers. METHOD For this convergent parallel, mixed-methods study using grounded theory methodologies, 12 dyads were recruited from the National Institutes of Health Clinical Center in Bethesda, Maryland, USA. Qualitative data collection focused on social interactions between cancer patients and their family caregivers to better understand and describe how post-treatment patients and caregivers create mutuality in their relationships, how they describe the processes of role-adjustment, and how these processes facilitate dyadic resiliency. Quantitative data collected through electronic survey included the Family Caregiving Inventory (FCI) for Mutuality Scale, Neuro QoL Ability to Participate in Social Roles and Activities, and Satisfaction with Social Roles and Activities-Short Forms, and Mental Health Continuum-Short Form (MHC). RESULTS Eleven participants were spouses. Twenty-two self-reported as Caucasian. The sample ranged from 35 to 71 years of age (Caregiver M = 53.7, Patient M = 54.3). Most of the caregivers were female (n = 8; 66.7%) and most of the patients were male (n = 9; 75%). Qualitative interview data illuminated two primary psychosocial processes relating to resilience, role adjustment and mutuality, as key facilitators for transformation and growth within dyadic partnerships coping with the challenges of cancer treatment and cancer caregiving. The FCI-mutuality score for patients (M = 3.65 ± 0.47) and caregivers (M = 3.45 ± 0.42) reflected an average level of relationship quality. Relative to participation in, and satisfaction with social roles and activities, patients (M = 50.66 ± 7.70, M = 48.81 ± 6.64, respectively) and caregivers (M = 50.69 ± 8.6, M = 51.9 ± 8.75, respectively) reported scores that were similar to the US General Population (M = 50 ± 10). CONCLUSIONS New patterns of role adjustment and mutuality can assist with making meaning and finding benefit, and these patterns contribute to dyadic resilience when moving through a cancer experience. There are few interventions that target the function of the dyad, yet the emergent model identified in this paper provides a direction for future dyadic research. By developing interventions at a dyadic level, providers have the potential to encourage dyadic resilience and sustain partnerships from cancer treatment into survivorship.
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Affiliation(s)
- Susanne W Gibbons
- Uniformed Services University of the Health Sciences, Bethesda, MD, 20815, USA.
| | - Alyson Ross
- National Institutes of Health, Clinical Center, Bethesda, MD, 20815, USA.
| | - Leslie Wehrlen
- National Institutes of Health, Clinical Center, Bethesda, MD, 20815, USA.
| | - Stephen Klagholz
- National Institutes of Health, Clinical Center, Bethesda, MD, 20815, USA.
| | - Margaret Bevans
- National Institutes of Health, Clinical Center, Bethesda, MD, 20815, USA.
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21
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Cardinali P, Migliorini L, Rania N. The Caregiving Experiences of Fathers and Mothers of Children With Rare Diseases in Italy: Challenges and Social Support Perceptions. Front Psychol 2019; 10:1780. [PMID: 31428029 PMCID: PMC6690318 DOI: 10.3389/fpsyg.2019.01780] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
Family caregiving is a growing phenomenon with the increased prevalence of chronic illness and shorter hospitalizations. Rare diseases pose significant challenges not only to patients living with these kinds of pathologies but also to those who care for these patients. The caregiving role has specific characteristics. The present work aims to increase knowledge of the challenges that are common or specific to fathers and mothers of children diagnosed with a rare disease. Moreover, the paper analyses the kinds of social support they experience according to gender. A descriptive study was conducted using grounded theory methodology. A semi-structured interview with open-ended questions was conducted with 15 parents of children with a rare disease. The interview was organized into three main areas: personal experiences in caring for a child with a rare disease, family changes and perceived social support. The transcriptions were analyzed using NVivo 11 software. From data analysis, themes emerged regarding the challenges shared by fathers and mothers, but some aspects also emerged that were gender-specific. The analyses of differences between mothers' and fathers' narratives showed that there is a specific experience of the impact that caregiving has on parents' relationships with their jobs and on their worries. Self-help group is the main source of social support for all respondents. We discuss these findings in relation to possible appropriate specific interventions and support for family caregiving.
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Affiliation(s)
- Paola Cardinali
- Department of Educational Science, University of Genoa, Genoa, Italy
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22
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Moral-Fernández L, Frías-Osuna A, Moreno-Cámara S, Palomino-Moral PA, Del-Pino-Casado R. The start of caring for an elderly dependent family member: a qualitative metasynthesis. BMC Geriatr 2018; 18:228. [PMID: 30253750 PMCID: PMC6157059 DOI: 10.1186/s12877-018-0922-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 09/16/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The family often takes care of an elderly person who suddenly becomes dependent. This greatly affects different aspects of the caregivers' lives. The aim of this study is to explore the initial experiences, during the first year of care, of persons who suddenly become caregivers for elderly dependent relatives. METHODS A search in CINAHL, PsycINFO, WOS, Medline, and Scopus and a metasynthesis of qualitative research were conducted including 19 articles. RESULTS Three categories were developed to explain the process of becoming a caregiver 'taking on the role' (life changes, uncertainty and confusion, and acceptance or resistance); 'beginning to realise' (new needs, impact, and appraisal); and 'implementing strategies' (seeking help and self-learning, reordering family and social relationships, solving problems, and devising strategies to decrease negative emotions and stress). CONCLUSIONS The synthesis provides a comprehensive understanding of the experience of becoming a caregiver in order to help health-care professionals to adapt care plans to this situation.
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Affiliation(s)
- Lourdes Moral-Fernández
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Antonio Frías-Osuna
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Sara Moreno-Cámara
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Pedro A. Palomino-Moral
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Rafael Del-Pino-Casado
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
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23
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Taylor JO, Hartzler AL, Osterhage KP, Demiris G, Turner AM. Monitoring for change: the role of family and friends in helping older adults manage personal health information. J Am Med Inform Assoc 2018; 25:989-999. [PMID: 29726993 PMCID: PMC7646862 DOI: 10.1093/jamia/ocy037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Although family and friends (FF) often play a significant support role in the health of older adults (OA), we know little about their role in personal health information management (PHIM). To address this gap and inform the design of PHIM tools, we describe the work, needs, and barriers of FF in the context of PHIM for OAs. Methods We conducted semi-structured telephone interviews with 52 FF identified by OA as being important in their health and PHIM. We analyzed interview transcripts for themes about FF information work, barriers, and support needs. Results FF play a supportive role in OA health maintenance, medical encounters, decision making, and daily activities. Monitoring, the ongoing process of seeking information related to the OA status, emerged as a key activity comprised of 3 phases: detection, interpretation, and action. Barriers to monitoring included OA choices and constraints, FF constraints, and difficulty with technological tools, resources, health information exchange between providers, social network dynamics, and physical distance. Conclusions FF frequently monitor for change in OA well-being, seeking up-to-date information to facilitate support of OA PHIM. Health information technology tools designed for FF can support all phases of monitoring by providing: (1) timely and granular levels of access to OA health information as the OA ages; (2) tailored health education for FF that is based on OA clinical data; and (3) networking platforms that integrate delegation, volunteering, and relevant resources, along with tools to facilitate support of OA appointment calendars and medication management. Such tools could reduce the burden of PHIM for OA and their loved ones.
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Affiliation(s)
- Jean O Taylor
- Northwest Center for Public Health Practice, Seattle, WA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
| | - Katie P Osterhage
- Northwest Center for Public Health Practice, Seattle, WA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anne M Turner
- Northwest Center for Public Health Practice, Seattle, WA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
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24
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Underwood J, Rhodes C. A qualitative investigation of hospital visitors' experiences using the analytic lens of liminality: Informing nursing practice and policy. Nurs Inq 2018; 25:e12239. [PMID: 29790231 DOI: 10.1111/nin.12239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 11/28/2022]
Abstract
This research aimed to inform nursing practice and policy by identifying satisfying and problematic experiences of hospital visitors during the hospitalisation episode of a significant other. An extensive contextual review revealed that healthcare systems in advanced economies face multiple pressures and that in England, the government leaves the determination of hospital visiting rules to individual trusts. The analytic lens of liminality provides rich interpretations of visitors' accounts and demonstrates the importance to visitors of structure (hospital rules and systems) and communitas (social bonding among liminal personae). Supportive hospital structures reduce the challenges of liminality and increase satisfaction. The data further suggest an extension to current understandings of liminality. Strong structure and successful communitas permit a safe exit from liminality after the hospitalisation episode for visitors with a close emotional bond with the patient.
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Affiliation(s)
- Janet Underwood
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Christine Rhodes
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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25
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Ornstein KA, Kelley AS, Bollens-Lund E, Wolff JL. A National Profile Of End-Of-Life Caregiving In The United States. Health Aff (Millwood) 2018; 36:1184-1192. [PMID: 28679804 DOI: 10.1377/hlthaff.2017.0134] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To date, knowledge of the experiences of older adults' caregivers at the end of life has come from studies that were limited to specific diseases and so-called primary caregivers and that relied on the recollections of people in convenience samples. Using nationally representative, prospective data for 2011, we found that 900,000 community-dwelling Medicare beneficiaries ages sixty-five and older who died within the following twelve months received support from 2.3 million caregivers. Nearly nine in ten of these caregivers were unpaid. Compared to other caregivers, end-of-life caregivers provided nearly twice as many hours of care per week and, especially in the case of spousal caregivers, reported more care-related challenges. Yet older adults at the end of life were not significantly more likely than other older adults to receive caregiving funded by government, state, or private insurance. To meet the needs of older adults at the end of life, their unpaid caregivers must receive greater recognition and expanded access to supportive services.
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Affiliation(s)
- Katherine A Ornstein
- Katherine A. Ornstein is an assistant professor in the Department of Geriatrics and Palliative Medicine and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, in New York City
| | - Amy S Kelley
- Amy S. Kelley is an associate professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Evan Bollens-Lund
- Evan Bollens-Lund is an analyst in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Jennifer L Wolff
- Jennifer L. Wolff is a professor in the Department of Health Policy and Management at Johns Hopkins University, in Baltimore, Maryland
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Ebadi A, Sajadi SA, Moradian ST, Akbari R. Suspended Life Pattern: A Qualitative Study on Personal Life Among Family Caregivers of Hemodialysis Patients in Iran. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2018; 38:225-232. [PMID: 29720038 DOI: 10.1177/0272684x18773763] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose To determine the personal life of family caregivers of patients undergoing hemodialysis. Methodology In this qualitative study, individual semistructured interviews were carried out with 19 caregivers of hemodialysis patients. All interviews were recorded, typed, and imported into the Open Code Software. The Graneheim and Lundman's content analysis approach was used for the analysis. Findings The theme of this study was suspended life pattern that was extracted from two categories of "Imbalance between caregiving and life" and "ambiguity in life status." The category of "Imbalance between caregiving and life" included some subcategories including compulsive compliance, suspension, and deferral of roles, conflicts between leisure time and caregiving and caregivers' time limits. Moreover, the category "ambiguity in life" was extracted from two subcategories of fear and hope and life satisfaction depending on care recipients' condition. Conclusion Caring for hemodialysis patients leads to instability and ambiguity in a caregiver's personal life. Therefore, authorities, policymakers, and health-care providers should pay more attention to support these people.
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Affiliation(s)
- Abbas Ebadi
- 1 Behavioral Sciences Research Center, Life Style Institute,Nursing Faculty, Baqiyatallah University of Medical Sciences,Tehran, Iran
| | - Seyedeh A Sajadi
- 2 Nursing Faculty, AJA University of Medical Sciences, Tehran, Iran
| | - Seyed T Moradian
- 3 Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Roghayeh Akbari
- 4 Department of Internal Medicine, Babol University of Medical Sciences, Babol, Iran
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Moral-Fernández L, Frías-Osuna A, Moreno-Cámara S, Palomino-Moral PA, Del-Pino-Casado R. [The first moments of the carer: The process of becoming a caregiver of a dependent elderly relative]. Aten Primaria 2017; 50:282-290. [PMID: 28735721 PMCID: PMC6837060 DOI: 10.1016/j.aprim.2017.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 04/27/2017] [Accepted: 05/03/2017] [Indexed: 12/02/2022] Open
Abstract
Objetivo Describir el proceso inicial por el que pasan las personas que se convierten inminentemente en cuidadores de algún familiar mayor en situación de dependencia. Diseño Estudio cualitativo cuyo análisis se ha regido por los principios de la teoría fundamentada. Emplazamiento El estudio se ha realizado en los distritos sanitarios de Jaén, durante 2015 y 2016, a nivel comunitario. Participantes y/o contextos La captación se realizó mediante los enfermeros gestores de casos de los Centros de Salud de cada distrito sanitario, los cuales localizaron participantes que cumpliesen los criterios de inclusión y los invitaban a participar en el estudio. Método Se han llevado a cabo 11 entrevistas en profundidad a personas que llevan cuidando menos de un año a un familiar mayor con dependencia hasta la saturación de la información. Resultados Tres fases han sido descritas durante este proceso. Una fase inicial de cambios, en los que la persona cuidadora asume nuevas actividades; una segunda fase atestada de emociones, en la que emergen necesidades y consecuencias en las personas cuidadoras; y una tercera fase donde destaca la aceptación como estrategia de afrontamiento y la incertidumbre como expectativa de futuro. Discusión La descripción de este proceso proporciona una mejor comprensión de la experiencia de convertirse en persona cuidadora familiar, con el fin de ayudar a los profesionales de la salud a adaptar los planes de atención a esta situación inicial.
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28
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Ross A, Shamburek R, Wehrlen L, Klagholz SD, Yang L, Stoops E, Flynn SL, Remaley AT, Pacak K, Shelburne N, Bevans MF. Cardiometabolic risk factors and health behaviors in family caregivers. PLoS One 2017; 12:e0176408. [PMID: 28472106 PMCID: PMC5417518 DOI: 10.1371/journal.pone.0176408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/09/2017] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to compare components of cardiometabolic risk and health behaviors of 20 family caregivers of allogeneic hematopoietic stem cell transplant patients to those of age, gender, and race/ethnicity-matched controls. A prospective, repeated measures design was used to compare cardiometabolic risk and health behaviors in caregivers and controls at three time-points: pre-transplantation, discharge, and six weeks post-discharge. Measures included components of metabolic syndrome, Reynolds Risk Score, NMR serum lipoprotein particle analyses, and the Health-Promoting Lifestyle Profile II (HPLP-II). Mixed-model repeated measure analyses were used. There were no between or within group differences in LDL cholesterol, HDL cholesterol, and triglycerides. There was a significant interaction effect between time and role in large VLDL concentration (VLDL-P) (F (2, 76) = 4.36, p = .016), with the trajectory of large VLDL-P increasing over time in caregivers while remaining stable in controls. Within caregivers, VLDL particle size (VLDL-Z) was significantly larger at time-point three compared to time-points one (p = .015) and two (p = .048), and VLDL-Z was significantly larger in caregivers than in controls at time point three (p = .012). HPLP-II scores were lower in caregivers than controls at all time-points (p < .01). These findings suggest that caregiving may have a bigger impact on triglycerides than on other lipids, and it is through this pathway that caregivers may be at increased cardiometabolic risk. More sensitive measurement methods, such as NMR lipoprotein particle analyses, may be able to detect early changes in cardiometabolic risk.
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Affiliation(s)
- Alyson Ross
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
| | - Robert Shamburek
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Leslie Wehrlen
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Stephen D. Klagholz
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Li Yang
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Elyssa Stoops
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sharon L. Flynn
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Alan T. Remaley
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Karel Pacak
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Nonniekaye Shelburne
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Margaret F. Bevans
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
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Whitehead L, Jacob E, Towell A, Abu-Qamar M, Cole-Heath A. The role of the family in supporting the self-management of chronic conditions: A qualitative systematic review. J Clin Nurs 2017; 27:22-30. [PMID: 28231630 DOI: 10.1111/jocn.13775] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the contribution of family members in promoting and supporting the self-management of chronic conditions amongst adult family members. BACKGROUND The prevalence of chronic disease continues to grow globally. The role of the family in chronic condition management and support for self-management has received little attention. DESIGN A systematic review of qualitative literature using the Joanna Briggs Institute approach for qualitative systematic reviews. METHODS Ovid (MEDLINE, CINAHL and PsycINFO) were searched for the period of database inception-2016. The QARI (Qualitative Assessment and Review Instrument) critical appraisal instrument was used to assess the quality of each study. Using the Joanna Briggs Institute-QARI data extraction tool, findings related to the family role in the self-management of chronic conditions were extracted and each finding rated according to Joanna Briggs Institute-QARI levels of credibility. Findings were categorised and synthesised to produce a final set of aggregated findings. RESULTS Families were key in constructing an environment that was conducive to family engagement and support. Adaptation within the family included maintaining cohesion between family members, normalisation and contextualisation of the chronic condition. CONCLUSIONS Whilst evidence on the value of the family in promoting positive health outcomes is clear, research on how families can specifically support the self-management of chronic conditions is emerging. RELEVANCE TO CLINICAL PRACTICE Family adaptability has been found to be the most powerful predictor of carer depression. Families may need support to change their home and family organisation to adapt to the challenges they face overtime. Change in roles and subsequent adaptation can be stressful, even for those family members at a distance. Nurses working in hospital and community settings can play an important role in assessing how families are adapting to living with chronic illness and to explore strategies to cope with challenges in the home setting.
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Affiliation(s)
- Lisa Whitehead
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Elisabeth Jacob
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Amanda Towell
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Ma'en Abu-Qamar
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Amanda Cole-Heath
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, WA, Australia
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Knafl K, Whittemore R. Top 10 Tips for Undertaking Synthesis Research. Res Nurs Health 2017; 40:189-193. [DOI: 10.1002/nur.21790] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Kathleen Knafl
- Frances Hill Fox Distinguished Professor; School of Nursing; University of North Carolina at Chapel Hill; 408 Carrington Hall Chapel Hill NC 27599
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31
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Birt L, Poland F, Csipke E, Charlesworth G. Shifting dementia discourses from deficit to active citizenship. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:199-211. [PMID: 28177147 DOI: 10.1111/1467-9566.12530] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Within western cultures, portrayals of dementia as 'a living death' are being challenged by people living with the diagnosis. Yet dementia remains one of the most feared conditions. The sociological lens of citizenship provides a conceptual framework for reviewing the role of society and culture in repositioning dementia away from deficit to a discourse of agency and interdependence. Awareness of cognitive change, and engaging with the diagnostic process, moves people into a transitional, or 'liminal' state of uncertainty. They are no longer able to return to their previous status, but may resist the unwanted status of 'person with dementia'. Drawing on qualitative studies on social participation by people with dementia, we suggest that whether people are able to move beyond the liminal phase depends on acceptance of the diagnosis, social capital, personal and cultural beliefs, the responses of others and comorbidities. Some people publicly embrace a new identity whereas others withdraw, or are withdrawn, from society to live in the shadow of the fourth age. We suggest narratives of deficit fail to reflect the agency people with dementia can enact to shape their social worlds in ways which enable them to establish post-liminal citizen roles. (A Virtual Abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA).
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Affiliation(s)
- Linda Birt
- School of Health Sciences, University of East Anglia, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, UK
| | - Emese Csipke
- Division of Psychiatry, University College London, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
- Research and Development Department, North East London NHS Foundation Trust, UK
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Point S, Fendt J, Jonsen K. Qualitative Inquiry in Management: Methodological Dilemmas and Concerns in Meta‐Analysis. EUROPEAN MANAGEMENT REVIEW 2016. [DOI: 10.1111/emre.12097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sébastien Point
- EM Strasbourg Business SchoolUniversité de Strasbourg Strasbourg France
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Clemmensen TH, Busted LM, Søborg J, Bruun P. The family's experience and perception of phases and roles in the progression of dementia: An explorative, interview-based study. DEMENTIA 2016; 18:490-513. [PMID: 27927946 PMCID: PMC6376601 DOI: 10.1177/1471301216682602] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper examines how the relatives of a person with dementia experience challenges in everyday life. A model of phases is developed on the basis of interviews with 14 relatives from eight families. Data were subjected to a thematic content analysis, which found that the progression of dementia - from the perspective of the family - had three phases. These phases involved small changes in everyday life, adaptations to everyday life, and the loss of everyday life. The analysis further identified the following two archetypes of relatives that develop throughout the progression of dementia: the protective relative and the decisive relative. The study found that the two types of relatives experience different challenges during the three phases. It is important for health professionals to be familiar with these changes, when they evaluate whether the relatives of a person with dementia require help.
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Affiliation(s)
- Trine H Clemmensen
- Department of Physiotherapy, University College Lillebaelt, Denmark; Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
| | - Laila M Busted
- Department of Nursing, University College Lillebaelt, DK Health Sciences Research Centre, University College Lillebaelt, Vejle, Denmark
| | - Jane Søborg
- Department of Occupational Therapy, University College Lillebaelt, DK Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
| | - Poul Bruun
- Health Sciences Research Centre, University College Lillebaelt, Vejle, Denmark
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McDermid F, Peters K, Daly J, Jackson D. Developing resilience: Stories from novice nurse academics. NURSE EDUCATION TODAY 2016; 38:29-35. [PMID: 26860520 DOI: 10.1016/j.nedt.2016.01.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 12/21/2015] [Accepted: 01/12/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND It is acknowledged that novice nurse academics face many challenges on commencement of their new role. Most are recruited from the clinical arena, with little understanding of the academic triumvirate of teaching, research and service. They struggle with role expectation and experience feelings of isolation and anxiety. AIM The aim of this paper is to report on an exploration of 14 new nurse academics from two major nursing education institutions as they utilised and developed resilience building strategies. METHOD The paper is drawn from a qualitative study that sought to see the world through the eyes of the participants through storytelling. Data was collected using semi-structured, conversational style interviews. Interviews were audio recorded and revealed themes that captured resilience strategies. RESULTS These themes were: Developing supportive collegial relationships; Embracing positivity; and Reflection and transformative growth. The first theme, developing supportive relationships, provides insight into the mentoring process and the relationships developed with peers and colleagues. The second theme, embracing positivity, describes the factors that assisted them to face the adversity and challenges in the new role. The final theme, reflection and transformative growth, demonstrated participants' reflecting on difficult situations and demonstrating the ability to learn from the experiences and move forward. CONCLUSIONS The strategies utilised by the participants in this study were key factors in the development of resilience which assisted in the transition from clinical nurse to academic. These strategies were often tacit and it is imperative that in a time of acute nurse academic shortages where retention is paramount, that employing organisations support employees and contribute to resilience development. Education on resilience building strategies is fundamental for all new academics and is essential in the transition from clinical nurse to academic.
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Affiliation(s)
- Fiona McDermid
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Kath Peters
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - John Daly
- Faculty of Health, University of Technology, Sydney, PO Box 123, Broadway, NSW 2007, Australia
| | - Debra Jackson
- Faculty of Health & Life Sciences, Oxford Brookes University, United Kingdom; Nursing Research, Oxford University Hospitals NHS Trust, Oxford OX3 0FL, United Kingdom; University of New England, Armidale, Australia
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