Validation of family conflict scales for family caregivers of persons with dementia in long-term care facilities and exploration of family conflicts and support

Patterns of Family Conflict and Accusations of Abuse in Dementia Family Caregivers: A Latent Class Analysis

BACKGROUND AND OBJECTIVES

Family conflict is a stressor for dementia family caregivers, yet its impact may differ based on the relationship between caregivers and their recipients. This study's objectives were to categorize caregivers into groups based on family conflict, examine whether the relationship to the recipient influences group membership, and determine whether these groups are associated with engaging in abusive and neglectful behaviors.

RESEARCH DESIGN AND METHODS

This national, cross-sectional study of 453 dementia family caregivers used latent class analysis to generate groups based on family conflict and abuse accusations. A multinomial logistic regression determined if relationship type (i.e., being a spouse, child, or grandchild to the care recipient or having a nontraditional relationship) predicted group membership. Groups were examined as predictors of abusive and neglectful behaviors using analysis of variance.

RESULTS

A 4-class solution emerged as the best fit: 3 groups with varying probabilities of family conflict and 1 group with elevated probabilities of abuse and neglect accusations. Relationship typed predicted membership in these classes. Group membership predicted abusive and neglectful behaviors.

DISCUSSION AND IMPLICATIONS

Adult children were more likely to experience high amounts of family conflict, whereas nontraditional caregivers were less likely to experience abuse and neglect accusations. Membership in the accusations group was a unique risk factor for abusive and neglectful behaviors. These findings support the need for continued investigation of family conflict in dementia caregivers. They also call to examine how family relationship types, including nontraditional family structures, influence caregiving outcomes.

Nurses' support needs in providing high-quality palliative care to persons with dementia in the hospital setting: A cross-sectional survey study

BACKGROUND

Since dementia is an irreversible progressive disease characterized by a decline in mental functions and overall health, a palliative care approach is recommended. Nevertheless, many persons with dementia experience burdensome hospitalizations in end-of-life care. Their quality of life during hospitalization can be improved by palliative nursing care that suits their fragile health.

AIM

To explore hospital nurses' perceived support needs while providing high-quality palliative care for persons with dementia and to identify differences between nurses in different ward types and at different educational levels.

DESIGN

Cross-sectional, multicenter survey study.

METHOD

Between January 2021 and April 2021, a convenience sample of Dutch hospital nurses received a web-based questionnaire on the topics of palliative caregiving, communication, collaboration, and hospital admissions. The data were analyzed using descriptive statistics.

RESULTS

The survey was completed by 235 nurses. The most frequently endorsed support needs were "communicating with persons with severe dementia" (58.3%), "appointing a permanent contact person in the care for persons with dementia" (53.6%), and "dealing with family disagreement in end-of-life care" (53.2%). If nurses had more time to provide care, 66.4% of them would prioritize providing personal attention. Most support needs identified by nurses were similar.

CONCLUSION

A heterogeneous group of nurses demonstrates overall similar support needs in providing palliative care for persons with dementia and their families in the hospital setting.

CLINICAL RELEVANCE

Nursing practices should implement dementia-friendly interventions to improve the quality of dementia care in the hospital.

Characteristics associated with neuropsychiatric symptoms in persons living with dementia and caregiver distress and diminished well-being

BACKGROUND

The population of persons living with dementia (PLWDs) is increasing, although mainstream dementia care quality is suboptimal.

PURPOSE

To identify characteristics associated with: (1) PLWDs' neuropsychiatric symptoms and quality of life; and (2) distress from neuropsychiatric symptoms and well-being among their family caregivers (N = 49).

METHODOLOGY

Cross-sectional single-group examination of PLWD and caregivers when they enrolled into a nurse-led dementia-centered primary care clinic. Pearson correlations were run between characteristics of PLWD and caregiver and variables representing PLWD's neuropsychiatric symptoms and quality of life and their caregivers' well-being. Statistically significant correlations were reported via Cohen d statistics.

RESULTS

Caregivers' characteristics associated with higher distress from neuropsychiatric symptoms and diminished well-being included Black race, female gender, younger age, caring for a parent with dementia, and being employed. Characteristics of PLWD associated with caregivers' higher distress and diminished well-being included longer time since dementia onset, higher Charlson Comorbidity Index, and non-Alzheimer dementia. Caregivers' characteristics associated with higher neuropsychiatric symptom burden included Black race, female gender, younger age, caring for parent PLWD, and being employed. Characteristics of PLWDs associated with higher neuropsychiatric symptom burden included non-Alzheimer dementia, longer time since dementia onset, more comorbidities, and higher Charlson Comorbidity Index. Finally, a longer time since dementia onset was associated with PLWDs' lower quality of life.

CONCLUSIONS

Black race, caring for caring for a parent with dementia, younger age, and being employed were characteristics linked to PLWDs' higher neuropsychiatric symptom burden and caregivers' diminished well-being.

IMPLICATIONS

Clinicians must assess and intervene with unpaid caregivers who may not appear obviously distressed.

Investigating the relationship between quality of life and hope in family caregivers of hemodialysis patients and related factors

Background

Family caregivers of hemodialysis patients are the first and most crucial source of care at home. They experience many problems in the care of hemodialysis patients, which can affect their quality of life and hope, affecting the quality of care provided to patients. This study aimed to determine the relationship between quality of life and hope in family caregivers of hemodialysis patients.

Methods

A cross-sectional (descriptive-analytical) study performed on 300 family caregivers in the east of Mazandaran province in Iran. Data were collected using the Family Caregiver Quality of Life (FQOL), SF8 and adult hope scale. Data analysis was performed in SPSS version 16, and a P-value of below 0.05 was considered statistically significant.

Results

The results showed that, there was a direct and significant relationship between hope and quality of life. However, the quality of life was significantly lower in suburban residents, the unemployed, spouses, people with lower education and income levels, caregivers who cannot leave their patients alone, those living with their patients in the same house, and those taking care of male patients, compared to other participants (P < 0.05). Suburban residents, the unemployed, people with an insufficient level of income, and those living with their patients in the same house had significantly lower hope, compared to other subjects.

Conclusion

Since an increase of hope and quality of life of caregivers can cause improved quality of patient care, it is recommended that hope-based educational programs and interventions be implemented for caregivers.

Review of nursing diagnosis validation studies: caregiver role strain

OBJECTIVE

To analyze the nursing diagnosis NANDA-I - Caregiver Role Strain validation studies.

METHODS

Integrative literature review. Research of studies carried out between 2000 and 2018 with the descriptors: caregivers, nursing diagnosis and validation study in the following databases: Web of Science, EBESCOhost, Scielo Brasil and Portugal, LILACS, RCAAP, CAPES, NANDA-I website, and in the bibliographic references of the articles. Articles in Portuguese, English or Spanish were included.

RESULTS

The sample consisted of seven validation studies, with heterogeneity in the methodologies used. The populations where the diagnosis was clinically validated focused on caregivers for the elderly and people with chronic illness. The most prevalent defining characteristics were Stress and Apprehension related to the future.

CONCLUSIONS

This diagnosis requires further validation studies among different populations in search of greater accuracy and a reduction in the number of defining characteristics, facilitating the use of taxonomy.

Designing and Validation of Health-Related Quality of Life Inventory for Family Caregivers of Hemodialysis Patients

Background:

Family caregivers are important sources of care for hemodialysis patients. Although caring for a family member is a pleasant feeling, experiencing lots of physical and psychological caregiving burden influences the quality of life among family caregivers of hemodialysis patients. This study aimed to design and validate the quality of life inventory for family caregivers of patients on hemodialysis.

Methods:

A sequential-exploratory mixed method was conducted in Tehran, Iran, in 2017-2018. In the qualitative phase, the researcher conducted in-depth semi-structured interviews with 19 participants. Finally, a pool of 93 items was extracted from this phase. Then, psychometric properties such as face validity (Impact Score>1.5), content validity ratio (CVR>0.63), content validity index (Item Content Validity Index: ICVI>0.78 , Scale Content Validity Index/Average: SCVI/Ave>0.8) and Kappa value (Kappa>0.7, internal consistency (Cronbach’s alpha>0.7), relative reliability (ICC: interclass correlation coefficient), absolute reliability (Standard Error of Measurement: SEM and Minimal Detectable Changes: MDC), convergent validity (Correlation Coefficient between 0.4-0.7), interpretability, responsiveness, feasibility, and ceiling and floor effects were assesse.

Results:

The quality of life inventory for family caregivers of hemodialysis patients was developed with 34 items and five factors (namely patient care burden, conflict, positive perception of situations, self-actualization, fear, and concern). The findings confirm that the scale is acceptable regarding validity, reliability and other measurement features.

Conclusions:

This inventory is consistent with the health care status in Iran. Therefore, it can be used to measure the quality of life among family caregivers of hemodialysis patients.

Development of the empowerment scale for family caregivers of community-dwelling people with dementia in Japan

AIM

This study aimed to develop the empowerment scale for family caregivers of community-dwelling people with dementia (PWD) in Japan (EFCD) and to validate the scale.

METHODS

The questionnaires were mailed to 820 family caregivers of PWD. The first version of the EFCD based on interviews with family caregivers and elderly care specialists and content validity results was tested. Participants also completed the Revised Scale for Caregiving Self-Efficacy and the General Health Questionnaire. For the EFCD development procedure, construct validity was evaluated by item analysis and exploratory factor analysis. Criterion validity was tested using Spearman's correlations between scores of the three scales. Reliability was evaluated using Cronbach's alpha, intraclass correlation coefficients (ICC), and Bland and Altman analysis. The final model was verified by confirmatory factor analysis.

RESULTS

Data from 304 family caregivers were analyzed. Exploratory factor analysis identified a 16-item, four-factor structure for the final version of the EFCD, as follows: (a) Excellent Practice in Dementia Care; (b) Understanding the Essence of Dementia Care; (c) Caring for Oneself as well as for the Person with Dementia; and (d) Having Peers with Shared Support Activities. Reliability and validity of the scale was established using the methods described.

CONCLUSIONS

The developed EFCD is a reliable and valid measure that provides a simple assessment of empowerment among family caregivers of PWD.