Perception of social support among family caregivers of vegetative patients: A qualitative study

Thematic Analysis of Psychosocial Stressors and Adaptive Coping Strategies Among Informal Caregivers of Patients Surviving ICU Admission for Coma

BACKGROUND

Family caregivers of patients with severe acute brain injury (SABI) admitted to intensive care units (ICUs) with coma experience heightened emotional distress stemming from simultaneous stressors. Stress and coping frameworks can inform psychosocial intervention development by elucidating common challenges and ways of navigating such experiences but have yet to be employed with this population. The present study therefore sought to use a stress and coping framework to characterize the stressors and coping behaviors of family caregivers of patients with SABI hospitalized in ICUs and recovering after coma.

METHODS

Our qualitative study recruited a convenience sample from 14 US neuroscience ICUs. Participants were family caregivers of patients who were admitted with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, traumatic brain injury, or hypoxic-ischemic encephalopathy; had experienced a comatose state for > 24 h; and completed or were scheduled for tracheostomy and/or gastrostomy tube placement. Participants were recruited < 7 days after transfer out of the neuroscience ICU. We conducted live online video interviews from May 2021 to January 2022. One semistructured interview per participant was recorded and subsequently transcribed. Recruitment was stopped when thematic saturation was reached. We deductively derived two domains using a stress and coping framework to guide thematic analysis. Within each domain, we inductively derived themes to comprehensively characterize caregivers' experiences.

RESULTS

We interviewed 30 caregivers. We identified 18 themes within the two theory-driven domains, including ten themes describing practical, social, and emotional stressors experienced by caregivers and eight themes describing the psychological and behavioral coping strategies that caregivers attempted to enact. Nearly all caregivers described using avoidance or distraction as an initial coping strategy to manage overwhelming emotions. Caregivers also expressed awareness of more adaptive strategies (e.g., cultivation of positive emotions, acceptance, self-education, and soliciting social and medical support) but had challenges employing them because of their heightened emotional distress.

CONCLUSIONS

In response to substantial stressors, family caregivers of patients with SABI attempted to enact various psychological and behavioral coping strategies. They described avoidance and distraction as less helpful than other coping strategies but had difficulty engaging in alternative strategies because of their emotional distress. These findings can directly inform the development of additional resources to mitigate the long-term impact of acute psychological distress among this caregiver population.

The experiences of the caregivers caring for the patients in persistent vegetative state due to traumatic brain injury

Objective

Persistent vegetative state often occurs as a result of traumatic brain injuries; these patients are usually hospitalized for sustained periods, and the family caregivers are the main care providers in Iranian hospitals, especially for chronic and persistent vegetative state patients. The current study was conducted to investigate the family caregivers' experiences of caring for persistent vegetative state patients following traumatic brain injury.

Methods

This descriptive phenomenological study was carried out in 2019. Semi-structured interviews were done with 12 family caregivers caring for the patients in persistent vegetative state, hospitalized in a trauma center, after taking informed written consent and assuring about anonymity and confidentiality of their personal information. The interviews were analyzed using the Colaizzis҆ method.

Results

After analysis of 12 interviews, 5 themes, and 10 subthemes were extracted from 428 codes. Five themes include "uncountable struggles/challenges," "looking for peace," "therapeutic concerns," "preserving the connection," and "unheard sounds."

Conclusion

In this study, the family caregivers of the persistent vegetative state patients in the hospital experienced some challenges, and looked for peace by doing some work, for example, praying. They had some therapeutic concerns and unheard sounds and tried to fulfill them. We recommend, by using the results of this study and other related research, necessary care and facilities would be provided for the family caregivers of persistent vegetative state patients in hospitals.

Needs of Family Members of Intensive Care Patients

This article reports the results of a research project designed to identify the needs of family members and others who are coping with hospitalization of loved one in the intensive care unit, thus alleviating stress. The health care provider's viewpoints were also considered. Study participants were 9 family members of intensive care unit patients and 24 health care providers working in intensive care units. Data were collected and analyzed from 24 individual interviews (average of 35 minutes per interview) and 1 focus group interview (1 hour). The findings revealed 2 basic needs: (1) reducing concerns and (2) being supported. The first need could be addressed by open visitation, access to information, assurance of quality of care, and empowerment via education and involvement. The second need could be met by emotional support, access to facilities, and postdischarge support. Health care providers and decision makers can use these results to respond to these needs and increase people's satisfaction of intensive care unit services.

Muslim caregivers' experiences in caring for patients receiving peritoneal dialysis

BACKGROUND

Fulfilling the role of a family caregiver has a substantial effect on the lives of those involved. However, existing information on family caregivers of patients receiving peritoneal dialysis is insufficient-especially Muslim caregivers, whose practice is unique.

OBJECTIVES

The aim of this study was to understand the experiences of Muslim family caregivers looking after patients receiving peritoneal dialysis in an Islamic context.

DESIGN

A descriptive qualitative approach was employed.

PARTICIPANTS

Thirteen Muslim family caregivers who have cared for patients undergoing peritoneal dialysis for at least 1 month.

APPROACH

Data were collected through face-to-face in-depth interviews and a focus group discussion. Content analysis was used to analyse the data with initial codes grouped into sub-categories, generic categories, and main categories.

FINDINGS

The experiences of Muslim family caregivers looking after patients receiving peritoneal dialysis generated two main categories: overwhelmed with suffering and learning to live as a caregiver.

CONCLUSIONS

Caregiving has a substantial impact on Muslim family caregivers. They need to be cared for holistically. The recognition of Islamic beliefs, doctrine of Allah, and religious practices are clear spiritual anchors for caregiving. The findings provide a deeper understanding of the experiences of Muslim family caregivers looking after patients receiving peritoneal dialysis. These findings could serve as the basis for developing a specific nursing intervention for such caregivers.

Post-Discharge Plight Of Patients With Chronic Disorders Of Consciousness: A Systematic Review Of Socioeconomic And Health Aspects

Objective — the presented study aims to systematize and structure significant information regarding the problems of patients with disorders of consciousness (DOC) and their families after discharge from the hospital, and to search for possible solutions. Material and Methods — to identify eligible studies, we searched the Medline database (via PubMed) for studies on socioeconomic and medical issues of patients with chronic DOC at the post-hospital stage of rehabilitation for the last 20 years. Results — we included 28 studies with 21 cohorts of patients from 7 different countries in our study. The components of informal caregiver burden and their impact on the quality of life were identified and systematized. These components include high physical load, high economic costs, vast time expenditures, strong emotional involvement, and a top level of expertise in caregiving, all of which are required from the relatives. Conclusion — It was affirmed, that the lack of healthcare system support was a major contributing factor to the overall burden. Our research also showed that delivering care without receiving information, advice, and training is extremely painful for family caregivers.

Planes de negocio de intervenciones de enfermería: Programa “Cuidando a los Cuidadores®”

Introducción: En Colombia el 65,51% de las atenciones prestadas fueron por enfermedades crónicas no transmisibles. Estas generan algún grado de discapacidad y dependencia, requiriendo un cuidador. Objetivo: Establecer una propuesta de plan de negocio para el programa “Cuidando a los cuidadores”, orientada al análisis de costos, económico y financiero. Materiales y Métodos: Estudio de evaluación económica de un programa de enfermería, con análisis de costos el cual se llevó a cabo en 4 pasos: 1) Caracterizar la estructura de costos del programa, 2) Elaborar las proyecciones, 3) Establecer el valor comercial de los niveles del programa, y 4) Evaluar mediante indicadores financieros la información obtenida en los pasos anteriores, para determinar la viabilidad económica del programa. Resultados: Se estima un costo anual de $6,9115 pronosticando a 5 años un costo anual de $8,732 en el nivel básico y de $7,131 en el nivel de seguimiento del programa. Los recursos para la implementación del programa son de $6,101, presentando un incremento patrimonial de $12,177 entre 2019 y 2023. Finalmente, la tasa interna de retornoTIR es de 326,19%, lo que indica que por cada $1 invertido, retornarán $326, concluyendo que el programa financieramente es rentable. Discusión: Se realizó el análisis únicamente del programa “Cuidando a Cuidadores®”, debido a que no existen en Colombia programas con características similares. Conclusión: “Cuidando a los cuidadores”, es un programa con un potencial de crecimiento en Colombia, debido al beneficio social que ofrece, y a la escaza competencia que presenta. La evaluación financiera demostró que es rentable.

The multiplicity of caregiving burden: a qualitative analysis of families with prolonged disorders of consciousness

Objective: To understand the multiple and sometimes conflicting roles substitute decision makers (SDMs) of individuals in a vegetative state (VS), minimally conscious state (MCS), or with locked-in syndrome (LIS) perform while caring for a loved one and the competing priorities derived from these roles.Methods: We conducted semi-structured qualitative interviews using a constructive-grounded theory design. Twelve SDMs, who were also family members for 11 patients, were interviewed at two time points (except one) for a total of 21 in-depth interviews.Results: Participants described that caregiving is often the central role which they identify as their top priority and around which they coordinate and to some extent subordinate their other roles. In addition to caregiving, they participated in a wide variety of roles, which were sometimes in conflict, as they became caregivers for a loved one with chronic and complex needs. SDMs described the caregiver role as complex and intense that lead to physical, emotional, social, and economic burdens.Conclusion: SDMs report high levels of burdens in caring for a person with a prolonged disorder of consciousness. Lack of health system support that recognized the broader context of SDMs lives, including their multiple competing priorities, was a major contributing factor.

Information Seeking Experiences of Family Caregivers of Patients with Persistent Vegetative State: A Qualitative Study

Background:

Providing care for patients in Persistent Vegetative State (PVS) by family caregivers without enough training and knowledge may be problematic both for the patients and for the caregivers. Therefore, the present study tries to explain the experiences of family caregivers of patients with PVS of seeking information needed to provide adequate care.

Materials and Methods:

Twenty two participants, including 17 family caregivers and 5 professional caregivers were enrolled by purposive sampling into this qualitative content analysis study, carried out between 2013 and 2015. Unstructured interviews and field notes were used to gather the data. Data collection was stopped when data saturation was achieved. Data analysis was performed by content analysis based on Graneheim and Lundman's approach.

Results:

As a result of the analysis of the collected data a main theme emerged labeled as “Seeking constructive education” with three categories including “Neglected requisite education,” “Greedy search for useful education” and “Dynamic independence in care.”

Conclusions:

In this study, information seeking by family caregivers of patients with PVS was constructive. Family caregivers insistently sought needed information from various sources. Ultimately, they found these insistent efforts beneficial and fruitful, because their efforts made them independent in providing care for their patients.

The experience of family caregivers caring for a patient with chronic disorders of consciousness: a qualitative content analysis

BACKGROUND

Management of a patient with chronic disorders of consciousness is a long-term and stressful situation for family caregivers.

AIMS

The aim of this study was to describe the experiences of family caregivers of patients with chronic disorders of consciousness.

METHODS

Purposeful sampling was used, data were collected through semi-structured, in-depth interviews at participants' homes. Data were analysed using qualitative content analysis.

FINDINGS

Results indicated that family caregivers of patients with chronic disorders of consciousness face many difficulties in providing care to vegetative state (VS) and minimally conscious state (MCS) patients; they experience it as a challenging type of care, which influences their mental health.

CONCLUSION

Family caregivers are faced with many challenges because of the high burden of care, round-the-clock concern, taking care of an alive but unresponsive patient without receiving enough support. They experience mental and inner turmoil because of social isolation and dealing with contradictory feelings in their daily life.

Efecto de una intervención de soporte social en cuidadores de personas con enfermedad crónica

Objetivo: determinar el efecto de la intervención de enfermería “Alguien apoya al que cuida” sobre las percepciones de soporte social y de sobrecarga con el cuidado de cuidadores familiares de personas con enfermedad crónica.Metodología: estudio de tipo cuantitativo cuasiexperimental con un grupo experimental y de control, al que se le realizó medición antes y después de la intervención aplicando los instrumentos de soporte social percibido de Sherbourne y Stewart y entrevista de sobrecarga de Zarit en un total de 137 participantes que cumplieron con los criterios de inclusión de ser cuidador principal por más de seis meses y estar vinculado al programa “Cuidando a los Cuidadores®” de la Facultad de Enfermería de la Universidad Nacional de Colombia. Los datos fueron analizados por medio de estadística descriptiva e inferencial no paramétrica en la que se aplicó la prueba de Mann-Whitney para el análisis intergrupos.Resultados: no existe diferencia significativa entre grupos en las mediciones pre y posprueba en ninguna de las variables, además se presenta un mínimo cambio entre las medias de la variable de sobrecarga entre la pre y la posprueba del grupo experimental.Conclusión: se advierte que el efecto mínimo de la intervención propuesta se presenta por la multidimensionalidad del soporte social, además del uso de otro tipo de TIC diferentes a las propuestas en este estudio.

Information Needs Assessment among Parents of Children with Cancer

Background: Parents of children with leukemia should be receiving an extensive amount of information about the care of their child; the aim of this study was to determine the parents’ information needs of children with leukemia. Methods: A cross-sectional study design was used to describe medical, physical, mental and lifestyle information needs among parents of children with leukemia. 209 parents of children diagnosed with leukemia in the west of Iran, during winter 2018, voluntarily participated in individual interviews. Data were analyzed by SPSS version 16 using t-test, One-way ANOVA and bivariate correlations statistical tests at 95% significant level. Results: The mean age of participants was 39.45 years [95% CI: 38.35, 40.55], ranged from 27 to 58 years. Participants achieved 55.6% score of information needs. There was a significant relationship between higher education level (P< 0.001), better economic status (P=0.008) and more family size member (P=0.003) with information needs. Conclusion: Findings suggest that parents of children with leukemia need the information to learn how to take care of their childhood and could be useful for guiding implementers to planning and implement effective programs to promotion information of parents towards children with cancer.

Trapped like a butterfly in a spider's web: Experiences of female spousal caregivers in the care of husbands with severe mental illness

AIMS AND OBJECTIVES

To explore the experiences of female spousal caregivers in the care of husbands with severe mental illness.

BACKGROUND

Family involvement in the care of patients with chronic illness is essential to provide a backbone of support for them. However, little is known about how female spousal caregivers are confronted with challenges while taking care of their husbands with severe mental illness.

DESIGN

An exploratory qualitative study.

METHODS

Fourteen female spousal caregivers of people with severe mental illness (defined here as schizophrenia, schizoaffective disorders and bipolar affective disorders) were recruited using purposive sampling and were interviewed using a semistructured in-depth interview method. Data were analysed by conventional content analysis until data saturation was achieved.

RESULTS

Care of a husband with severe mental illness had a disruptive influence on the emotional relationships of the family and resulted in emotional detachment over time. Despite the caregivers' struggle to protect their families, the lack of supportive resources caused emotional exhaustion. Caregiving tasks interfering with their many other responsibilities, along with being a reference for family matters, led to loss of self. Consequently, they experienced psychological distress because of the transition to a caregiver role without any supportive resources.

CONCLUSION

Constant caring, without supportive resources, forced them to do various roles and manage other issues within the family. Being unprepared for a caregiving role led to the psychological distress of female spousal caregivers. Therefore, adequate information, education and supportive resources must be provided for spouses to facilitate their transition to caregiving roles.

RELEVANCE TO CLINICAL PRACTICE

It is necessary to pay close attention to the spousal caregivers' own mental health problems while they care for their mentally ill husbands. Mental health professionals should adopt a new approach to the prioritisation and planning of policies that support both family caregivers and patients.

Prevalence, Cognitive and Socio-Demographic Determinants of Prostate Cancer Screening

Screening may be effective for reducing deaths due to prostate cancer. The aim of this study was determine the prevalence and determinants influencing prostate cancer early detection behaviors based on the theory planned behavior (TPB). In this cross-sectional study, conducted in the west of Iran, a total of 250 men aged 50 to 70 years old were randomly selected to participate. Of these, 200 (80%) signed the consent form and voluntarily agreed to take part. A structured questionnaire based on TPB constructs was applied for collecting data by interview. Analyses were conducted with SPSS version 16 using bivariate correlations, and logistic and linear regression. Some 26.5% of the participants demonstrated prostate cancer early detection behavior. Age higher than 60 (OR: 5.969), academic education (OR: 2.904), number of family members more than four (OR: 3.144), and knowledge about prostate cancer (OR: 3.693) were the most influential predictive factors for early detection behavior. Furthermore, among the TPB constructs, attitude (OR=1.090) and subjective norms (OR=1.280) were the most influential predictors. Attitude, subjective norms, and perceived behavioral control accounted for 43% of the variation in the outcome measure of the intention to screen for prostate cancer (adjusted R squared= 0.43, F= 49.270 and P < 0.001). Designing and implementation programs to increase positive attitudes and encourage subjective norms towards prostate cancer screening behavior may be useful for promotion of early detection.

The psychological impact of prolonged disorders of consciousness on caregivers: a systematic review of quantitative studies

OBJECTIVE

Systematic review of the nature, frequency and severity of psychological experiences of people who have a close relationship with a person with a prolonged disorder of consciousness.

DATA SOURCES

Cochrane Library, Web of Science, PsycINFO, PubMed, Embase^®, MEDLINE^®, Allied and Complementary Medicine™, were searched from inceptions until December 2016 with additional hand searching of reference lists of included articles.

REVIEW METHODS

Studies were included that used quantitative methodologies and psychological measures to investigate experiences. The PRISMA statement was followed with inclusion criteria set a priori. A data synthesis summarized psychological constructs studied.

RESULTS

A total of 18 studies (ranging between n = 16-487 participants) met the inclusion criteria with 15 of 18 studies focused on the primary caregiver. A total of 23 standardized psychological measures were identified to assess four primary psychological constructs: Loss and grief, psychological wellbeing changes, burden and use of coping strategies.

CONCLUSIONS

Small sample sizes, limited variables and reliance on observational methods affected quality. Caregivers do find ways to manage independently, but some exhibit clinically significant psychological distress that does not change over time alone and may get worse.