Caregivers' Concerns about Judgment and Safety of Patients with Brain Injury: A Preliminary Investigation

Organizational characteristics of Brain Injury Clubhouse Model programs

OBJECTIVE

We provide an overview of the Clubhouse Model and the history and development of Brain Injury Clubhouses. We describe organizational-level characteristics associated with eight Brain Injury Clubhouses to address gaps in the literature and inform future studies or program development.

METHODS

A electronic survey, the Clubhouse Profile Questionnaire (CPQ) was tailored for Brain Injury Clubhouses. The CPQ gathers program-level data that can be used to identify active ingredients of Clubhouses, understand best practices, examine, and evaluate program characteristics. The brain injury version of the CPQ was administered to a sample of eight Clubhouses affiliated with the International Brain Injury Clubhouse Association as part of a project designed to gather data on Clubhouse program characteristics and describe sociodemographic characteristics of people served by Brain Injury Clubhouses.

RESULTS

CPQ data from eight Brain Injury Clubhouses was analyzed. Brain Injury Clubhouse programs in this sample served approximately 17 members per day. There was wide variability in the size, funding and funding mechanisms, and length of operation of Brain Injury Clubhouses in this study.

CONCLUSIONS

Findings suggest that Brain Injury Clubhouses offer a wide range of services and supports. Additional research on the impact of Brain Injury Clubhouses is needed.

A New Stage of the Caregiving Career: Informal Caregiving After Long-Term Institutionalization

BACKGROUND AND OBJECTIVES

The "unexpected career" of caregiving has previously been conceptualized in stages: community care through institutional placement/residence, ending with death of the care recipient. Transition programs such as Money Follows the Person (MFP) created a new stage of the caregiving career, caring for someone post-long-term institutionalization, about which little is known. Using Pearlin's Caregiver Stress Process Model, this study explores effects on caregivers from the return of their loved ones to the community after a long-term institutional stay.

RESEARCH DESIGN AND METHODS

Cross-sectional surveys of 656 caregivers of persons transitioned through Connecticut's MFP program 2014-18, completed 6 months post-transition.

RESULTS

Regardless of the age/disability of the care recipient, and despite experiencing high caregiving intensity, caregivers experienced less burden, anxiety, and depression, and higher benefits of caregiving than demonstrated in literature for the general caregiving population. Most felt less stressed than before and during the participant's institutional stay. Factors associated with worse outcomes included worry about safety, strained finances, missing work, and desiring additional services. Black and Hispanic caregivers experienced lower burden and anxiety and higher benefits of caregiving than White caregivers.

DISCUSSION AND IMPLICATIONS

By providing community supports to participants, transition programs can have broad ancillary benefits for caregivers and improve outcomes in the Pearlin model, lessening potentially deleterious effects of an unexpected return to intensive caregiving duties after institutional placement. Positive results for Black and Hispanic caregivers may reflect cultural expectations in caring for family that buffer the adverse effects of caregiving.

Health, wellness, and safety concerns of persons with moderate-to-severe traumatic brain injury and their family caregivers: a qualitative content analysis

BACKGROUND

Persons with moderate-to-severe traumatic brain injury (TBI) face issues with health, wellness, and safety that affect their ability to independently manage their care, even for individuals who are ≥75% independent in activities of daily living. These issues often lead to increased family involvement in managing the person's condition after discharge home.

PURPOSE

We explored health, wellness, and safety concerns after discharge home from inpatient rehabilitation from the perspectives of persons with TBI who are ≥75% independent in activities of daily living and their family caregivers.

MATERIALS AND METHODS

We interviewed 27 persons with TBI and family caregivers and used conventional content analysis to analyse the data.

RESULTS

Seven themes related to health, wellness, and safety encompassed participants' experience. Health themes included: (1) attempting to manage medications and (2) navigating mental health difficulties. Wellness themes included: (1) working to stay physically active, (2) dealing with sleep and sleeplessness, and (3) adjusting to changing social relationships. Safety themes were: (1) addressing mobility challenges and (2) compensating for complications with cognitive functioning.

CONCLUSIONS

Findings can guide the development of tools, supports, and resources to promote health, wellness, and safety of persons with TBI as they recover after discharge home.Implications for rehabilitationFindings on numerous concerns related to health, wellness, and safety suggest the need for implementation or development and testing of tools, supports, and resources to promote health, wellness, and safety of persons with traumatic brain injury as they recover after discharge home.Our findings can be used to educate healthcare providers and increase awareness of the nuanced challenges patients and families face after discharge home.Findings can also be used by providers to educate patients and families on realistic expectations for life after discharge.

Families' Needs of Patients With Acquired Brain Injury: Acute Phase and Rehabilitation

PURPOSE

The aim of this study was to identify and compare the needs of families of patients with acquired brain injury (ABI) in acute care and rehabilitation settings.

DESIGN

A descriptive exploratory study was conducted.

METHODS

Data were collected in the acute care setting and in the rehabilitation setting during meetings with families (n = 54) of patients with ABI using the Family Needs Questionnaire.

FINDINGS

In both settings, families identified obtaining information about ABI or the patients' health as the most important need, followed by support from health professionals.

CONCLUSION

For families, accessing information about the disease situation was important regardless of patients being in the acute care or rehabilitation phase. To provide tailored care for these families, it is important to assess information needs systematically early in the acute phase of hospitalization.

CLINICAL RELEVANCE

A paradigm shift is desirable to include families in care, identify their needs, and support them in a more tailored way.

The Safety Assessment Measure for persons with traumatic brain injury: Item pool development and content validity

BACKGROUND

Persons with moderate to severe TBI are at increased risk for unintentional injury or harm in the home and community; however, there is currently no standard measure of safety risk they face now and in the future.

OBJECTIVE

To develop comprehensive and content valid scales and item pools for assessing safety and risk for persons with moderate to severe traumatic brain injuries.

METHOD

Qualitative psychometric methods for developing scales and items were used including literature review, item development and revision, focus groups with interdisciplinary rehabilitation staff (n = 26) for rating content validity, and cognitive interviewing of TBI family members (n = 9) for assuring item clarity.

RESULTS

The Safety Assessment Measure is comprised of 6 primary scales - Cognitive Capacity, Visuomotor Capacity, Wheelchair Use, Risk Perception, Self-Regulation, and Compliance Failures with Safety Recommendations - in which family caregivers or clinicians rate the risk for unintentional injury or harm in adults who have sustained moderate or severe TBI. The scale item pools encompass a broad spectrum of everyday activities that pose risk in the home and community and were rated as having excellent levels of content validity.

CONCLUSIONS

The Safety Assessment Measure scales and items cover a broad range of instrumental activities of daily living that can increase the risk of unintentional injuries or harm. Empirical evidence suggests that the Safety Assessment Measure items have excellent content validity. Future research should use modern psychometric methods to examine each scale unidimensionality, model fit, and precision.

Loss of Financial Management Independence After Brain Injury: Survivors’ Experiences

OBJECTIVE. This pilot study explored the experiences of brain injury survivors after a change in financial management (FM) independence.

METHOD. Using a qualitative descriptive design, 6 participants with acquired brain injury were recruited from a community brain injury organization and participated in semistructured interviews. Data were analyzed using thematic analysis.

RESULTS. Three themes emerged from the interviews: (1) trajectory of FM change, involving family members as key change agents; (2) current FM situation, involving FM strategies such as automatic deposits and restricted budgets; and (3) the struggle for control, in which survivors desired control while also accepting supports for FM.

CONCLUSION. This study identifies some of the challenges brain injury survivors face in managing their finances and the adjustment associated with a loss of FM independence. Occupational therapists should be aware of clients’ experiences when supporting them through a change in independence.

Initial experiences of family caregivers of survivors of a traumatic brain injury

Background

There seems to be a paucity of research on the initial subjective experiences of family caregivers of survivors of a traumatic brain injury (TBI).

Objective

To explore the challenges that family caregivers face during the initial stages of recovery of a relative who has sustained a TBI.

Methods

Thematic analysis was used to explore the findings from semi-structured interviews that were conducted with 12 female family caregivers of relatives who had sustained a TBI.

Results

Family caregivers recalled their initial experiences of the shock at hearing the news about their relative’s TBI, negative experiences in hospital and frustrating interactions with healthcare professionals as particularly challenging.

Conclusion

The findings of this study emphasise caregivers’ need for support, information and psycho-education, especially from healthcare professionals, from the very beginning stages of recovery from a TBI. Practical and physical needs with regard to admission to and care in the hospital were also highlighted. This research will hopefully contribute to creating awareness amongst healthcare professionals on how they can contribute to improvement of the services provided by the healthcare system based on the experiences of the caregivers who participated in this study.