Sense of relatedness and interpersonal network of adult offspring caregivers: linkages with crisis, emotional arousal, and perceived health

Factors that contribute to adult children caregivers' well-being: a scoping review

The ageing of the population will increasingly result in reliance on the family for care in the community. Existing reviews have provided insights into the needs and health outcomes of family caregivers, but are disproportionately skewed towards spousal caregivers. Presently, a large majority of family caregivers are adult children. Adult children are distinct from spousal caregivers in terms of the combination of roles they occupy and the relationship they have with the care recipient. These unique considerations can have important implications for their well-being. A growing body of literature has investigated the factors that contribute to adult children caregivers' (ACCs) well-being; however, no reviews to date have synthesised this body of literature or appraised its methodological quality. Our objective was to identify the range and types of factors that contribute to ACC well-being across studies. A scoping review was conducted. Medline, Psycinfo, EMBASE and CINAHL databases (January 1996-August, 2012) were systematically searched for studies investigating ACC well-being. Inclusion/exclusion criteria were applied, methodological quality was appraised, the data were charted and a narrative synthesis was conducted. Fifty-five studies met our inclusion criteria. Factors that contribute to ACC well-being were found to be either: (i) care recipient-related (e.g. nature of limitations, amount of care required); (ii) caregiver-related (e.g. psychological dispositions of the ACC); or (iii) socially embedded (e.g. parent-child relationship, multiple role involvement, social support available to the ACC). Socially embedded factors that contribute to ACC well-being have received the most attention in the literature. Among these factors, ACC well-being is uniquely impacted by the quality of the parent-child relationship and combination of roles occupied. The majority of studies were cross-sectional. Future studies should therefore employ a longitudinal design to inform our understanding of the changes that take place in the parent-child relationship and multiple role involvement across the care-giving trajectory.

Reviewing the definition of crisis in dementia care

Background

Crisis is a term frequently used in dementia care lacking a standardized definition. This article systematically reviews existing definitions of crisis in dementia care literature to create a standardized definition that can be utilized for research, policy and clinical practice.

Methods

We systematically searched for articles containing definitions of crisis in the context of dementia care. We created an operational framework of crisis based on retrieved definitions. Recommendations to address crisis situations were reviewed and classified according to care settings.

Results

Abstracts and titles of 1,113 articles, screened from PubMed and EMBASE, were narrowed down to 27 articles. After review, crisis in dementia was defined as a process where a stressor causes an imbalance requiring an immediate decision to be made which leads to a desired outcome and therefore a resolution of the crisis. If the crisis is not resolved, the cycle continues. Recommendations for resolving crisis involving persons with dementia and their caregivers include awareness therapy after diagnosis and increased contact with general practitioners, case manager consultations, caregiver support and education. Furthermore, nursing home staff should be attuned to the environmental, physical and psychological needs of persons with dementia.

Conclusions

This is the first article to review the definition of crisis in the context of dementia care. A review of the literature indicated that the definition of a crisis is idiosyncratic. Therefore, it is difficult to prevent or plan for all crises. We used an operational framework to compile types of crisis stressors and recommendations from the crisis literature based on three different perspectives; the person with the dementia, the caregiver and the healthcare providers.

Self-coherence, emotional arousal and perceived health of adult children caring for a brain-impaired parent

An important concern for nurses is the ability of adult children to provide effective care to a dependent parent without sacrificing their own health and well-being. The purpose of the study was to examine 'sense of self-coherence' as an inner resource for the attenuation of distress in a sample of 168 adult children who were involved with the care of a brain-impaired parent. Subjects were interviewed twice in their homes in order to obtain data on variables for: self-coherence, emotional arousal, perceived health, and crisis. Findings from the study indicate that adult children with crisis experience in the previous 6 months of caregiving had higher scores for emotional arousal, lower scores for self-coherence, and lower ratings of perceived health than did adult children with no crisis experience. In addition, there was a negative relationship between self-coherence and emotional arousal and a positive relationship between self-coherence and perceived health. Both of these relationships were significantly stronger in the presence of crisis experience than in the absence of crisis experience. Finally, there was a negative relationship between emotional arousal and perceived health that was equally apparent in both the presence and absence of crisis experience. The findings suggest that self-coherence is an inner resource that emerges in filial crisis to modulate the emotional impact of the situation. The implication is that measures of self-coherence could be used to assess an adult child's preparedness to appraise and cope with emotional responses to filial crisis events. This information could help nurses anticipate and target resources for vulnerable adult children so that they are less adversely affected by the demands of parent care.

Salutogenic psychosocial nursing practice

Public affirmation of core principles for relating with clients is needed in order to assure continued viability of quality nursing practice in this era of competition and managed health care. Practitioners of professional nursing can reassert their legitimate claim to quality nursing care through an emphasis on the practice of salutogenic psychosocial nursing. The presumption is that clients, families, and communities who benefit from salutogenic nursing care are more likely to heal and stay well because they have developed competencies for managing the details of their health situations. This paper presents key characteristics of salutogenic psychosocial nursing, along with their implications for assuring quality nursing practice.