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Talebi E, Nobahar M, Foroughan M, Asgari MR. The inhibiting factors of adaptation to urinary incontinence in community-dwelling older adult women: A qualitative study. Geriatr Nurs 2024; 59:121-130. [PMID: 38996769 DOI: 10.1016/j.gerinurse.2024.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/10/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024]
Abstract
Urinary incontinence affects the physical, psychological, social and well-being of older adult women and requires adaptation. This study aimed to explain the inhibiting factors of adaptation to urinary incontinence in community-dwelling older adult women. A qualitative content analysis approach was adopted. Participants were 15 older women with urinary incontinence, three family members, and three healthcare team members. Data were collected by individual, in-depth semistructured interviews and analysed using the Graneheim and Lundman approach. The data analysis yielded the theme of neglecting urinary incontinence and the older adult, with four categories of "s silence-inducing beliefs", "worthlessness for the family", "non-adaptation of urban spaces", and "deficiencies in the healthcare service structure". Elucidating the inhibiting factors for older women's adaptation to urinary incontinence will lead to a change in the attitude of social policymakers and healthcare officials. This changes will then facilitate the establishment and adjustment of the necessary infrastructure to overcome these barriers.
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Affiliation(s)
- Elnaz Talebi
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Monir Nobahar
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran.
| | - Mahshid Foroughan
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Reza Asgari
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
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Chen S, Lou VWQ, Leung R, Yu DSF. Meaning-making of dementia caregiving: A systematic review of qualitative studies. Int J Nurs Stud 2024; 158:104848. [PMID: 39043114 DOI: 10.1016/j.ijnurstu.2024.104848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Being the backbone of informal care for people living with dementia, caregivers suffer overwhelming physical and psychological challenges in their daily caregiving experience. Proactive coping strategies to alleviate the caregiving burden are of utmost importance. Meaning-making emerges as an effective coping approach to benefit caregivers and mitigate their care burden. However, the conceptualisation of meaning-making on its dimensions and process has been ambiguously identified. OBJECTIVES To synthesise the qualitative research evidence on meaning-making in a dementia context to identify: (1) the situational dimension in making sense of caregiving scenarios, and (2) how the meaning-making process evolves during dementia caregiving. METHODS This systematic review identified 62 qualitative studies published between 1969 and 2022 from the major databases. Eligible studies met the following inclusion criteria: (1) having informal caregivers of people living with dementia; (2) involving meaning-making of care experience; (3) adopting qualitative design; and (4) full-text of research articles. The risk of bias was evaluated using the Clinical Appraisal Skills Programme checklist. By using Qualitative Evidence Synthesis, themes relevant to critical dimensions and phases of meaning-making were generated from the extracted data. RESULTS Sixty-two studies involving 2487 subjects were synthesised investigating the critical dimensions and process of meaning-making of dementia care experience. Results indicated that the dementia care experience can be made sense of in several folds: (1) it involved complicated demands from people living with dementia and requires customised care; (2) the dynamics of dyadic interactions with dilemma and ambivalence; and (3) adaptive coping encapsulating perceptions of loss and growth, complied and integrated values, balanced expectations of care and self, and improvement in self-efficacy. The meaning-making process underwent phases of meaning creation (meaning created in initial encounter with dementia symptoms), meaning appraisal (assimilation and accommodation pathways for appraisal), and meaning adherence (integration of the appraised meanings). CONCLUSION Findings suggest meaning-making of dementia caregiving is a multi-faceted and multi-phased recursive process. Future implications give directions on the facilitation of meaning-oriented interventions to enhance the awareness of caregiving role and the knowledge of dementia care, learn techniques of reframing and restructuring, and seek meaningful perspectives; and to adopt strategies to overcome the barriers for meaning-making by empowering self-identity, roles and expectations, and the dyadic relationship. In addition, our findings inform future advancement in the conceptualisation and measurement of meaning-making in the context of family caregiving. Optimisation of the meaning-making process inspires professional assistance to enhance caregivers' coping for dementia care experience.
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Affiliation(s)
- Shuangzhou Chen
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, Sau Po Center on Ageing, The University of Hong Kong, Hong Kong
| | - Vivian W Q Lou
- Department of Social Work and Social Administration, Sau Po Center on Ageing, The University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Reynold Leung
- Department of Social Work and Social Administration, Sau Po Center on Ageing, The University of Hong Kong, Hong Kong
| | - Doris S F Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, Sau Po Center on Ageing, The University of Hong Kong, Hong Kong.
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Buck J, Fromings Hill J, Collins R, Booth J, Fleming J. Effectiveness of non-pharmacological interventions delivered at home for urinary and faecal incontinence with homebound older people: systematic review of randomised controlled trials. Age Ageing 2024; 53:afae126. [PMID: 38941119 PMCID: PMC11212545 DOI: 10.1093/ageing/afae126] [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: 11/10/2023] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Incontinence is a common, distressing condition, most prevalent in older people. There is an unmet need for effective interventions to support continence. This review focuses on non-pharmacological interventions to reduce incontinence among homebound older people. Aim: to identify interventions with potential to be delivered by care workers, nurses or family members in a person's home. METHODS Multiple databases were searched until 15 September 2023 for randomised controlled trials reporting home-based interventions for incontinence for older people (≥65 years) living at home. Two reviewers independently screened titles, abstracts and papers against inclusion criteria, then assessed for the Risk of Bias (RoB2). A third reviewer resolved the discrepancies. Primary data were extracted and synthesised. RESULTS A full-text review of 81 papers identified seven eligible papers (1996-2022, all USA), including n = 636 participants (561 women and 75 men). Two studies focusing on multicomponent behavioural interventions showed benefit, as did one study of transcutaneous tibial nerve stimulation self-administered through electrode-embedded socks. Three, which included cognitively impaired people, reported improvement with toileting assistance programmes, but the effects were not all significant. Results were inconclusive from a study examining the effects of fluid intake adjustments. Interventions were delivered by nurses, three in collaboration with family caregivers. No faecal incontinence interventions met the criteria. CONCLUSION There is scant evidence for continence supporting interventions delivered in older people's own homes. With an ageing population often reliant on family or social care workers well-placed to support continence promotion and policy drives for services to support older people remaining at home, this evidence gap needs addressing.
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Affiliation(s)
- Jackie Buck
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Julia Fromings Hill
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Rachael Collins
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Joanne Booth
- Research Centre for Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jane Fleming
- Cambridge Public Health Interdisciplinary Research Centre, University of Cambridge, Cambridge, UK
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Shogenji M, Yoshida M, Kakuchi T, Hirako K. Factors associated with caregiver burden of toileting assistance at home versus in a nursing home: A cross-sectional study. PLoS One 2024; 19:e0299721. [PMID: 38452135 PMCID: PMC10919849 DOI: 10.1371/journal.pone.0299721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024] Open
Abstract
This study aimed to identify differences in caregiver burden related to toileting assistance, and examine the factors associated with the most burdensome aspects of providing toileting assistance. In 2019, a self-administered postal survey was conducted with 743 caregivers of older adults who received subsidies for continence products in Komatsu City, Japan. Both family caregivers and nursing home staff answered questions regarding older adults' urinary/fecal symptoms, toileting assistance, and perceived caregiver burden. Older adults living at home had less need for toileting assistance than those in nursing homes. However, family caregivers experienced more burden than nursing home staff. The most frequent physical burden associated with toileting assistance for family caregivers was urinary/fecal leakage from absorbent incontinence products. This burden was linked to family caregivers providing care at home, using a combination of urinary pads and diapers, and symptoms that caused burdens on caregivers including urinary/fecal incontinence, nocturia, and no desire to urinate. These results suggest that leakage caused by the inappropriate use of urinary pads combined with diapers is a source of caregiver burden. Continence care experts should provide guidance to family caregivers of older adults, particularly those who are underweight and frail, regarding the selection and fitting of absorbent incontinence products.
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Affiliation(s)
- Miho Shogenji
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa City, Ishikawa, Japan
| | - Mikako Yoshida
- Department of Women’s Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai City, Miyagi, Japan
| | - Takahiro Kakuchi
- Graceful Aging Division, Health & Welfare Department, Komatsu City Hall, Komatsu City, Ishikawa, Japan
| | - Kohei Hirako
- The Establishment Preparation Office for The Faculty of Interdisciplinary Economics, Kinjo University, Hakusan City, Ishikawa, Japan
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Li X, Li Y, Qian L, Han P, Feng H, Jiang H. Mothers' experiences of breast milk expression during separation from their hospitalized infants: a systematic review of qualitative evidence. BMC Pregnancy Childbirth 2024; 24:124. [PMID: 38341542 PMCID: PMC10858471 DOI: 10.1186/s12884-024-06323-3] [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: 07/11/2023] [Accepted: 02/06/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Mother-infant separation, which is occurring with an increasing incidence, is a barrier to direct breastfeeding. Owing to the importance of breast milk to hospitalized infants, mothers are actively encouraged to express milk during their infants' neonatal intensive care unit (NICU) stay. However, mothers are often faced with a number of challenges in this process. There is a need to understand such mothers' real-life experiences of breast milk expression to develop supportive strategies to reduce the burden on mothers and increase breastfeeding rates. METHODS A comprehensive search of 12 databases was conducted for relevant studies published from database construction to December 2022. All qualitative and mixed-method studies published in English and Chinese that reported on mothers' experiences of human milk expression during separation from their hospitalized infants were included. Two reviewers independently conducted screening, data extraction, and quality appraisal, with disagreements resolved by a third reviewer. The process of searching followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The JBI Qualitative Assessment and Review Instrument was used to assess study quality and the credibility of study findings. Meta-aggregation was performed to integrate the results. RESULTS This systematic review aggregated mothers' experiences of milk expression during separation from their hospitalized infants. Database search yielded 600 records, of which 19 full-text documents were screened. Finally, 13 studies of good quality were included with data from 332 mothers across seven countries. A total of 61 primary findings with illustrations were extracted from the 13 eligible studies, the findings were generalized into 16 categories, and further were concluded as four synthesized findings: purpose and motivation, physical and emotional experiences, barrier factors, and coping styles. CONCLUSION Mothers were driven by extrinsic motivation in their decision to express breast milk. They experienced physical exhaustion and many negative emotional feelings while expressing. This process was affected by numerous barriers. Social support was essential to the initiation and maintenance of milk expression. Medical staff and families should pay more attention to the mental health of mothers with infants in the NICU. Future research should incorporate strategies to cope with emotional responses and offer practical strategies for managing milk expression. SYSTEMATIC REVIEW REGISTRATION [ www.crd.york.ac.uk ], identifier [PROSPERO 2022 CRD42022383080].
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Affiliation(s)
- Xuemei Li
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yongqi Li
- School of Nursing, Naval Medical University, Shanghai, 200433, China
| | - Lin Qian
- Nursing Department, Shanghai East Hospital, Tongji University, Shanghai, 200120, China
| | - Peng Han
- Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Haoxue Feng
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Hui Jiang
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 201204, China.
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Hellman-Bronstein AT, Luukkaala TH, Ala-Nissilä SS, Nuotio MS. Do urinary and double incontinence predict changes in living arrangements and mobility in older women after hip fracture? - a 1-year prospective cohort study. BMC Geriatr 2024; 24:100. [PMID: 38273298 PMCID: PMC10811924 DOI: 10.1186/s12877-023-04637-z] [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: 06/06/2023] [Accepted: 12/24/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Continence problems are known to be associated with disability in older adults. Costs of disability and resulting need for more supported living arrangements are high after a hip fracture. The aim was to examine pre-fracture urinary incontinence (UI) and double incontinence (DI, concurrent UI and fecal incontinence) as predictors of changes in mobility and living arrangements in older female hip fracture patients in a 1-year follow-up. METHODS Study population comprised 1,675 female patients aged ≥ 65 (mean age 82.7 ± 6.8) sustaining their first hip fracture between 2007-2019. Data on self-reported pre-fracture continence status was collected. The outcomes were declined vs. same or improved mobility level and need for more assisted vs same or less assisted living arrangements 1-year post-fracture. Separate cohorts of 1,226 and 1,055 women were generated for the mobility and living arrangements outcomes, respectively. Age- and multivariable-adjusted logistic regression models were used to determine the associations of UI, DI, and other baseline characteristics with the outcomes. RESULTS Of the patients, 39% had declined mobility or more assisted living arrangements at 1-year follow-up. Adjusting for age, both pre-fracture UI and DI were associated with changes in mobility and living arrangements. In the multivariable analysis, UI (OR 1.88, 95% CI 1.41-2.51) and DI (1.99, 95% CI 1.21-3.27) were associated with decline in mobility level while only DI (OR 2.40, 95% CI 1.22-4.75) remained associated with the need for more assisted living arrangements. CONCLUSIONS Both pre-fracture UI and DI in older women are risk factors for declining mobility level, but only DI for more supported living arrangements 1-year post-hip fracture. UI likely develops earlier in life and might not necessarily be strongly associated with the onset or increasing disability in later years. DI may indicate more marked vulnerability and burden to patients as well as to formal and informal caregivers.
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Affiliation(s)
- Aino T Hellman-Bronstein
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland.
| | - Tiina H Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Seija S Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Zheng X, Qian M, Ye X, Zhang M, Zhan C, Li H, Luo T. Implications for long COVID: A systematic review and meta-aggregation of experience of patients diagnosed with COVID-19. J Clin Nurs 2024; 33:40-57. [PMID: 36253950 PMCID: PMC9874539 DOI: 10.1111/jocn.16537] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/19/2022] [Accepted: 09/06/2022] [Indexed: 01/27/2023]
Abstract
AIMS AND OBJECTIVES This review aims to synthesize the available evidence of what patients experience when infected with COVID-19, both in hospital and post-discharge settings. DESIGN This review was conducted using the Joanna Briggs Institute (JBI) methodology for qualitative systematic reviews and evidence synthesis. Reporting of results was presented according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist. BACKGROUND Coronavirus disease 2019 (COVID-19) continues to be a public health crisis worldwide. Many patients diagnosed with COVID-19 have varied levels of persisting mental disorders. Previous studies have reported the degree, prevalence and outcome of psychological problems. Minimal research explored the experience of patients with long COVID. The real-life experience of patients with COVID-19 from diagnosis to post-discharge can deepen the understanding of nurses, physicians and policymakers. METHODS All studies describing the experience of patients were included. Two authors independently appraised the methodological quality of the included studies using the JBI Critical Appraisal Checklist for Qualitative Research 2020. RESULTS This systematic review aggregated patients' experience of being diagnosed with COVID-19 in both hospitalized and post-discharge settings. Finally, 17 studies met inclusion criteria and quality appraisal guidelines. The selected studies in the meta-synthesis resulted in 12 categories, and further were concluded as five synthesized findings: physical symptoms caused by the virus, positive and negative emotional responses to the virus, positive coping strategies as facilitators of epidemic prevention and control, negative coping strategies as obstacles of epidemic prevention and control, and unmet needs for medical resource. CONCLUSIONS The psychological burden of patients diagnosed with COVID-19 is heavy and persistent. Social support is essential in the control and prevention of the epidemic. Nurses and other staff should pay more attention to the mental health of the infected patients both in and after hospitalization. RELEVANCE TO CLINICAL PRACTICE Nurses should care about the persistent mental trauma of COVID-19 survivors and provide appropriate psychological interventions to mitigate the negative psychological consequences of them. Besides, nurses, as healthcare professionals who may have the most touch with patients, should evaluate the level of social support and deploy it for them. It is also needed for nurses to listen to patient's needs and treat them with carefulness and adequate patience in order to decrease the unmet needs of patients.
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Affiliation(s)
- Xutong Zheng
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina
| | - Min Qian
- Department of NursingBeijing Ji Shui Tan Hospital and the 4th Medical College of Peking UniversityBeijingChina
| | - Xinxin Ye
- Department of Sports and Exercise ScienceZhejiang UniversityHangzhouChina
- School of Public HealthZhejiang University School of MedicineHangzhouChina
| | - Man Zhang
- School of MedicineYan'an UniversityYan'anChina
| | - Chenju Zhan
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina
| | - Hui Li
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina
| | - Tiantian Luo
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
- Department of Scientific ResearchXiamen Xianyue HospitalXiamenChina
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Yao Y, Zeng Q, Wang Y, Shi H, Zeng Y. Experiences and perspectives of nurses infected with COVID-19: A qualitative systematic review and meta-synthesis. Nurs Health Sci 2023; 25:530-542. [PMID: 37941525 DOI: 10.1111/nhs.13065] [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: 07/17/2023] [Revised: 10/03/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
This qualitative systematic review aims to comprehensively understand the experiences and perspectives of nurses infected with COVID-19, addressing a significant gap in the current literature. Following the JBI meta-synthesis approach, a rigorous search was conducted across nine electronic databases and references until January 16, 2023. Seventeen eligible studies underwent quality assessment using the JBI critical checklist. Data were synthesized using standardized tools, and the ConQual tool evaluated confidence in the findings. Seven key findings emerged, providing valuable insights into emotional experiences, adaptation to COVID-19 challenges, influence of support systems, coping strategies, posttraumatic growth perceptions, and effects on professional identity and career advancement. The findings highlight emotional toll, adaptive strategies, and professional implications for nurses. Moreover, they emphasize the importance of support systems, coping mechanisms, and posttraumatic growth in promoting nurses' well-being and resilience. These insights have practical implications for targeted interventions and support mechanisms to enhance infected nurses' well-being and improve healthcare outcomes.
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Affiliation(s)
- Yue Yao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qinglin Zeng
- School of Clinical Medicine, Sichuan College of Traditional Chinese Medicine, Mianyang, China
| | - Yuqiang Wang
- Department of Stomatology, Chengdu Fifth People's Hospital, Chengdu, China
| | - Huijing Shi
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yanli Zeng
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Su JJ, Abu-Odah H, Bayuo J, Lin RSY, Luo X, Molassiotis A. Experiences of Non-Family Paid Helpers Providing Palliative Care to Stroke Patients: The Toll of Professional Informal Caregiving in a Job Lacking Recognition. J Palliat Care 2023:8258597231210138. [PMID: 37904518 DOI: 10.1177/08258597231210138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Background: Employing non-family paid helpers has become a prevalent practice across North America, Europe, and Asia, which families adopt to alleviate the stroke care burden, allowing family to take a break from their obligations and perform other social activities. However, paid helpers' experiences of providing palliative care to stroke patients are under-explored. This study aimed to explore the caregiving experiences of non-family paid helpers providing palliative care to stroke patients. Method: A qualitative descriptive study was undertaken using purposive sampling and semi-structured individual in-depth interviews. Thematic analysis was used for data analysis. Results: Seventeen participants (mean age: 51.23 years) were included, predominantly being female (88%), and their caregiving experiences with patients ranged from four to 26 years. Participants shared that monetary compensation offset the exhaustion, familial and health sacrifices of palliative caregiving. They emphasized emotional self-management through accepting and coping or avoiding and distancing, and appreciated rewarding appraisals from stroke patients and family members. They also expressed a lack of recognition from the public, being invisible to the healthcare system/professionals, and insecurity in employment rights. Conclusions: Findings support the need for governmental initiatives to subsidize families in employing helpers to provide palliative care. Helpers perceived monetary compensation and a reciprocal caregiving relationship as the primary motives for providing care. Public recognition of this role as a helper in caregiving, contractual employment rights, and being recognized by the healthcare system and healthcare professionals are considerations in promoting quality care and alleviating a health care burden. The findings may contribute to further understanding of the experiences of non-family paid helpers in a job lacking recognition when delivering palliative care in a hospital for stroke patients. Evidence-based interventions that enhance reciprocity and recognition should be considered as part of the global initiatives to support paid helpers in palliative care.
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Affiliation(s)
- Jing Jing Su
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hammoda Abu-Odah
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Rose Sin Yi Lin
- School of Nursing, Elaine C. Hubbard Center for Nursing Research on Aging, University of Rochester, Rochester, New York, USA
| | - Xiaoling Luo
- Geriatrics Department, Guangzhou Medical University Second Hospital, Guangzhou, China
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- College of Arts, Humanities and Education, University of Derby, UK
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Fang S, Liang H, Liang Y. Relationship between person, environmental factors, and activities of daily living performance among physically disabled older adults living at home: a structural equation model. BMC Geriatr 2023; 23:285. [PMID: 37170103 PMCID: PMC10176859 DOI: 10.1186/s12877-023-04000-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Older adults with physical disability need long-term services and support, which incur enormous costs. However, supportive environments may reduce disability and promote aging in place. It is unclear how the physical and social environment affect different types of functional impairments and influence the performance of activities of daily living (ADL) in physically disabled older adults. OBJECTIVE The purpose of this study was to examine the relationship between person, environmental factors, and ADL performance among physically disabled older adults living at home. METHODS This was a cross-sectional study. Using long-term care insurance claims data from a pilot city in China, we used a structural equation model to assess the potential paths among person, environmental factors, and ADL performance. RESULTS Education and income had different influences on the social environment and physical environment. The functional impairments had significant effects on ADL performance, either directly or through physical environment (with handrails) and social environment (family support). CONCLUSIONS The present findings offer crucial evidence for understanding the interactions between a person and the environment, as well as their influence on physical ADLs, suggesting the importance of a supportive environment and a subpopulation-targeting strategy for disabled older adults.
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Affiliation(s)
- Shuai Fang
- Institute of Sociology, Shanghai Academy of Social Sciences, 622 Huaihai Middle Rd., Huangpu District, Shanghai, 200020, China
| | - Hong Liang
- School of Social Development and Public Policy, Fudan University, 220 Handan Rd., Yangpu District, Shanghai, 200433, China
| | - Yan Liang
- School of Nursing, Fudan University, 305 Fenglin Rd., Xuhui District, Shanghai, 200032, China.
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11
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Jaekel AK, Rings TM, Schmitz F, Knappe F, Tschirhart A, Winterhagen FI, Kirschner-Hermanns RKM, Knüpfer SC. Urinary and Double Incontinence in Cognitively Impaired Patients: Impacts on Those Affected and Their Professional Caregivers. J Clin Med 2023; 12:jcm12103352. [PMID: 37240458 DOI: 10.3390/jcm12103352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Urinary or double incontinence in frail elderly people is common and leads to a reduction in quality of life and an increased burden on the patients' caregivers. Up to now, no special instrument has been available to assess the impact of incontinence on cognitively impaired patients and their professional caregivers. Thus, the outcomes of incontinence-specific medical and nursing interventions for cognitively impaired individuals are not measurable. Our aim was to investigate the impacts of urinary and double incontinence on both the affected patients and their caregivers using the newly developed "International Consultation on Incontinence Questionnaire Cognitively Impaired Elderly" (ICIQ-Cog) tool. The severity of incontinence was measured by incontinence episodes per night/per 24 h, the type of incontinence, the type of incontinence devices used, and the proportion of incontinence care out of total care; all these measures were correlated to the ICIQ-Cog. Incontinence episodes per night and the proportion of incontinence care out of total care showed significant correlations with the patient- and caregiver-related ICIQ-Cog scores. Both items have negative effects on patient quality of life and caregiver burden. Improving nocturnal incontinence and reducing the need for incontinence care overall can decrease the incontinence-specific bother of affected patients and their professional caregivers. The ICIQ-Cog can be used to verify the impacts of medical and nursing interventions.
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Affiliation(s)
- Anke Kirsten Jaekel
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Neuro-Urology, Johanniter Neurological Rehabilitation Center 'Godeshoehe e.V.', 53177 Bonn, Germany
| | - Theresa Maria Rings
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Franziska Schmitz
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Franziska Knappe
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Alix Tschirhart
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | | | - Ruth Klara Maria Kirschner-Hermanns
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Neuro-Urology, Johanniter Neurological Rehabilitation Center 'Godeshoehe e.V.', 53177 Bonn, Germany
| | - Stephanie C Knüpfer
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
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Gledhill K, Bucknall TK, Lannin NA, Hanna L. Defining ready for discharge from sub-acute care: a qualitative exploration from multiple stakeholder perspectives. BMC Health Serv Res 2023; 23:425. [PMID: 37131178 PMCID: PMC10153031 DOI: 10.1186/s12913-023-09285-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/14/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Planning discharges from subacute care facilities is becoming increasingly complex due to an ageing population and a high demand on services. The use of non-standardised assessments to determine a patient's readiness for discharge places a heavy reliance on a clinician's judgement which can be influenced by system pressures, past experiences and team dynamics. The current literature focusses heavily on discharge-readiness from clinicians' perspectives and in the acute care setting. This paper aimed to explore the perceptions of discharge-readiness from the perspectives of key stakeholders in subacute care: inpatients, family members, clinicians and managers. METHODS A qualitative descriptive study was conducted, exploring the views of inpatients (n = 16), family members (n = 16), clinicians (n = 17) and managers (n = 12). Participants with cognitive deficits and those who did not speak English were excluded from this study. Semi-structured interviews and focus groups were conducted and audio-recorded. Following transcription, inductive thematic analysis was completed. RESULTS Participants identified that there are both patient-related and environmental factors that influence discharge-readiness. Patient-related factors discussed included continence, functional mobility, cognition, pain and medication management skills. Environmental factors centred around the discharge (home) environment, and were suggested to include a safe physical environment alongside a robust social environment which was suggested to assist to fill any gaps in functional capabilities (i.e. patient-related factors). CONCLUSIONS These findings make a unique contribution to the literature by providing a thorough exploration of determining discharge-readiness as a combined narrative from the perspectives from key stakeholders. Findings from this qualitative study identified key personal and environmental factors influencing patients' discharge-readiness, which may allow health services to streamline the determination of discharge-readiness from subacute care. Understanding how these factors might be assessed within a discharge pathway warrants further attention.
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Affiliation(s)
- Kate Gledhill
- School of Health and Social Development, Deakin University, Geelong, Australia.
- School of Primary and Allied Healthcare, Monash University, Frankston, Australia.
- Department of Occupational Therapy, School of Primary Health and Allied Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, VIC, 3199, Australia.
| | - Tracey K Bucknall
- School of Nursing and Midwifery, Deakin University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Lisa Hanna
- School of Health and Social Development, Deakin University, Geelong, Australia
- Institute of Health Transformation, Deakin University, Geelong, Australia
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Bektas Akpinar N, Unal N, Akpinar C. Urinary Incontinence in Older Adults: Impact on Caregiver Burden. J Gerontol Nurs 2023; 49:39-46. [PMID: 36989470 DOI: 10.3928/00989134-20230310-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
The objective of the current descriptive, cross-sectional, and relationship-seeking study was to evaluate the severity of urinary incontinence (UI) in older adults and its impact on care burden of their family caregivers. This study was performed prospectively with 80 older adults (aged ≥65 years) with UI and their family caregivers who attended a urology clinic between June and December 2021. UI was assessed using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF), and caregiver burden using the Zarit Burden Interview (ZBI). Increase in care time was associated with higher burden of care (p = 0.018). Post-hoc analyses suggested that caregivers' burden of care gradually increased up to the first 9 months. Daily care time >9 hours had a higher burden compared to care times <9 hours (p < 0.001). Mean ZBI score of caregivers was 41.47 (SD = 10.18) and mean ICIQ-UI-SF score of older adults was 15.02 (SD = 3.9). A significant correlation was observed between increased ICIQ-UI-SF scores of older adults and ZBI scores of caregivers (r = 0.354, p = 0.001). Caring for older adults with UI is associated with a significant burden of care and an increase in severity of UI is associated with increased burden of care. Female sex, lower educational level, presence of comorbidities, increased care time, and daily care hours were factors associated with increased burden of care among caregivers. [Journal of Gerontological Nursing, 49(4), 39-46.].
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Zheng X, Zhang J, Ye X, Lin X, Liu H, Qin Z, Chen D, Zhan C. Navigating through motherhood in pregnancy and postpartum periods during the COVID-19 pandemic: A systematic review and qualitative meta-synthesis. J Nurs Manag 2022; 30:3958-3971. [PMID: 36194367 PMCID: PMC9874529 DOI: 10.1111/jonm.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/06/2022] [Accepted: 09/30/2022] [Indexed: 01/27/2023]
Abstract
AIM The aim of this work is to critically appraise and synthesize the qualitative studies on the experiences, perspectives, and consequences of pregnant women experiencing motherhood during the COVID-19 pandemic. BACKGROUND The COVID-19 pandemic has posed a threat to the health of pregnant women. Such a pandemic disrupted their routine care, as well as normal daily life. However, little is known about their coping strategies to the changes brought by COVID-19. EVALUATION A qualitative systematic review was conducted according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist. A meta-aggregative approach rooted in pragmatism and Husserlian transcendental phenomenology was used to synthesize the findings. Dependability and credibility of both study findings and synthesized findings were appraised by Joanna Briggs Institute (JBI) ConQual process. KEY ISSUES Key issues include (a) pregnant women experienced changes in routine care, (b) pregnant women used a range of strategies to cope with the consequence of the pandemic, (c) pregnant women struggled to embrace motherhood, and (d) pregnant women received different levels of social support. CONCLUSION Facing challenges caused by the pandemic, pregnant women used a variety of strategies to cope with and adapt to the changes, but sometimes the adaption is limited. Emotional, instrumental, and informational support should be provided to them in an accessible way. IMPLICATIONS FOR NURSING MANAGEMENT As an essential part of policymakers, nursing managers should consider the balance between restriction and the accessibility of maternity care. It is also crucial for them to consider how to provide necessary support in an accessible way.
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Affiliation(s)
- Xutong Zheng
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina,School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
| | - Jiayu Zhang
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
| | - Xinxin Ye
- School of Public HealthZhejiang University School of MedicineHangzhouChina
| | - Xiaoyi Lin
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
| | - Huanju Liu
- Women's Hospital and the Institute of GeneticsZhenjiang University School of MedicineHangzhouChina
| | - Zhuzhu Qin
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
| | - Danfeng Chen
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
| | - Chenju Zhan
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina
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Managing incontinence in low-and middle income-countries: A qualitative case study from Pakistan. PLoS One 2022; 17:e0271617. [PMID: 35839232 PMCID: PMC9286225 DOI: 10.1371/journal.pone.0271617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/04/2022] [Indexed: 11/20/2022] Open
Abstract
Background Incontinence is a complex health and social issue, which involves the involuntary loss of urine or faeces or both. Individuals with disabilities are particularly vulnerable to incontinence. The management of incontinence has largely been overlooked in low and middle-income settings (LMICs). This study aimed to explore the incontinence management strategies employed by disabled people with severe incontinence and their caregivers in Sindh Province, Pakistan. Methods Incontinence management was explored through in-depth interviews with people with incontinence (PWI) and their caregivers, photovoice, and a market survey and product attribute assessment. Data was analysed thematically through inductive coding and evaluated against existing disability and caregiver frameworks. Results Incontinence management affected all aspects of daily life for PWI and caregivers. Effective management of incontinence was prioritised because caregivers viewed it to be part of their familial duty and a requirement for the household to remain pure in the eyes of God. Coping strategies included strict adherence to routines, reducing food and drink intake, creative uses of locally available natural resources, and a heavy reliance on soap and water for maintaining hygiene. Products such as adult diapers were largely unavailable, costly and were not deemed suitable for regular use. There were no social or medical interventions in the region to support incontinence management. The main impacts of incontinence on the household were social isolation, stigma, role shifts within the family, the development of physical ailments among caregivers, and decreased income. Conclusion The complex health, psychological, social, economic, and cultural impacts of incontinence are exacerbated in LMICs due a lack of recognition of the condition, the absence of social or medical interventions and limited access to basic WASH infrastructure, and assistive devices or products. Appropriate solutions need to be developed in partnership with PWI and caregivers and need to be contextualised, affordable and sustainable.
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