Conflict between Family Caregivers and Staff in Nursing Homes: Feasibility of the Daily Diary Method

A scoping review of intensive longitudinal methods in informal caregivers of people with dementia

BACKGROUND

The daily life of informal caregivers assisting individuals with dementia widely varies throughout the day and week. As an answer, an increasing number of researchers have used intensive longitudinal methods (ILMs) such as diary studies, experience sampling methods, or ecological momentary assessment.

OBJECTIVES AND METHODS

The present scoping review aims at synthesizing the use of ILMs in informal dementia caregivers to clarify what is currently done and how, as well as what remains unaddressed.

RESULTS

The screening process identified 48 studies from 22 different datasets. Synthesis of these studies showed the diversity of devices and uses of ILMs in informal care, including the exploration of associations between variables or accompanying an intervention. ILMs showed the important variability of caregiving phenomena, as well as the important association of momentary stress and well-being. Gaps were nevertheless identified, such as transparency in the construction of the tool or the absence of focus on emotions and dyads.

CONCLUSIONS

For now, this field of research remains in its infancy and does not seem to have reached its full potential as it has in other fields. Nevertheless, it appears that ILMs are promising tools for informal dementia caregivers as they contribute to understanding the complexity of their daily life, with changing resources and challenges. Future directions include focusing more on (emotion) regulation, temporal lags, and the use of ILMs in interventional designs.

TRIAL REGISTRATION

The present review was registered on OSF (osf.io/b2qr4).

Stressors and coping strategies in Chinese family caregivers of people with dementia in long-term care facilities: A qualitative descriptive study

OBJECTIVES

This study aimed to explore the stressors along with coping strategies in Chinese family caregivers whose relative with dementia had been placed into a long-term care facility.

METHODS

A qualitative descriptive study was conducted with 17 Chinese family caregivers of institutionalised older adults with dementia, recruited via purposeful sampling. Information regarding stressors along with coping strategies was collected through face-to-face semi-structured individual interviews. The interviews were audio-recorded, transcribed, anonymised and imported into MAXQDA 2018.2. Data were analysed with qualitative content analysis.

FINDINGS

Three categories of stressors emerged: socioeconomic pressure, hassles arising from continuing caregiving and suboptimal care provided by the facility. In particular, the family caregivers' experienced tremendous pressure of negative comments from people around since long-term care placement was traditionally viewed as unfilial in Chinese societies. Various coping strategies were adopted by Chinese family caregivers to deal with the stressors; however, they were not always adaptive.

IMPLICATIONS

Health care authorities and professionals should recognise family caregivers' stressors after long-term care placement of a relative with dementia with the consideration of the unique socio-cultural needs. Appropriate and effective interventions should be developed and implemented to facilitate family caregivers to cope with stressful situations after long-term care placement and further to safeguard their psychosocial well-being.

Nurse–Patient/Relatives Conflict and Patient Safety Competence Among Nurses

Nurse–patient/relatives conflicts may adversely impact the well-being and work performance of nurses, which could prelude to the possibility of unwanted errors thereby threatening patient safety. This descriptive and cross-sectional study aimed to examine the association between nurses’ perceived nurse–patient/family conflicts and their perceived patient safety (PS) competence. Nurse–patient/relatives conflicts are critical issues that may adversely impact the nurses’ well-being, which could prelude to unwanted errors, thereby threatening PS. The study surveyed 320 nurses in Saudi Arabia using the “Healthcare Conflict Scale” and “Health Professional Education in Patient Safety Survey” from December 2019 to January 2020. The subscale “mistrust of motivations” was perceived to have the greatest conflict, whereas “contradictory communication” was rated as the lowest conflict. A significant difference was observed between the perceived conflict and the different hospital units where nurses worked. Saudi nurses reported higher nurse–patient/family conflicts than Filipino and Indian nurses. The highest PS competence was reported in “communicating effectively,” whereas “working in teams with other health professionals” had the poorest safety competence. The nurses’ perceived “mistrust of motivations” and “contradictory communication” were associated with poorer self-reported PS competence. Perceived conflicts between nurses and their patients/relatives had negative association with the perceived confidence of nurses in the difference patient safety competencies. The results can become the basis for formulating hospital policies geared toward the elimination of healthcare conflicts to help ensure the patient safety competence of nurses. Policies on mitigating conflicts between healthcare workers and patients/relatives must be created and implemented.

Effectiveness of the Online Daily Diary (ONDIARY) program on family caregivers of advanced cancer patients: A home-based palliative care trial

OBJECTIVES

There are many effective palliative care programs for patients with advanced cancer. However, little is known about effective programs for family caregivers of patients with advanced cancer, especially in home-based palliative care settings. This study aimed to determine the effect of the Online Daily Diary (ONDIARY) program on the quality of life (QOL) of family caregivers of patients with advanced cancer in home-based palliative care settings.

METHODS

This study used a quasi-experimental design with a control group. The sample comprised 60 family caregivers (intervention group n = 30, control group n = 30) of patients with advanced cancer receiving home-based palliative care. The intervention group was assigned to the ONDIARY program in addition to usual care, and the control group was assigned to usual care. Group allocation was not randomized. The ONDIARY program is a 7-day online diary intervention program that aims to enhance emotional competence. Outcome measures were feasibility assessment, and primary and secondary outcome assessment. Primary and secondary outcome measures were the Caregiver Quality of Life Index-Cancer (CQOLC) and the six-item Kessler Psychological Distress Scale (K6). Repeated measures analysis of variance was performed on each measure, with group and group × time interactions.

RESULTS

There was a significant group × time interaction in CQOLC scores (F = 9.324, P = 0.003). The CQOLC scores of family caregivers in the intervention group were maintained after the intervention, whereas those in the control group declined. There was no significant difference in K6 scores between the two groups.

CONCLUSION

The results suggest that the ONDIARY program in addition to usual care has potential to be effective in preventing decline and maintaining QOL of family caregivers of patients with advanced cancer in home-based palliative care settings.

Physicians and Family Caregivers: Two Perspectives of Physicians' Roles in Long-Term Care

OBJECTIVES

We explored the roles of attending physicians of long-term care (LTC) residents in supporting their family caregivers (FCGs).

DESIGN

In this mixed-methods study, we conducted surveys and focus group interviews with physicians and FCGs.

SETTING AND PARTICIPANTS

There were 78 FCGs and 18 physicians in the survey, and 18 FCGs and 9 physicians in the focus groups. They were recruited from 5 urban LTC settings.

RESULTS

Although 83.3% of physicians reported they had experience caring for FCGs, 71.8% of FCGs perceived they had not received support from the physicians. There was no statistically significant difference between the FCGs' and physicians' mean responses to the mirrored survey questions. Both groups gave similar ratings, means neutral and agree indicative of ambivalence, on physician's knowledge to identify FCGs who need assistance, ability to assess FCG stress, and aid those experiencing distress and needing advocacy. Analysis of the focus groups revealed the overarching theme: ambiguity about the LTC residents' physicians' role in supporting FCGs. Although physicians noted that residents and families come as a unit, there was ambivalence about the physician's role in supporting FCGs. FCG roles in LTC are also vague. There were 3 sub-themes: "accord on the surface"; "tension in the interface"; and "smoothing the relationship." Both groups thought FCG medical care was beyond the purview of the resident's physician. Physicians and FCGs provided different explanations for the tensions in the FCG/physician interface. Physicians attributed tension to FCG stress and inadequate knowledge, whereas FCGs thought physicians' communication could be improved. Suggestions to smooth the relationship were to align FCG expectations to reality of LTC and different staffing models.

CONCLUSIONS AND IMPLICATIONS

Family physicians, policy makers, and FCGs will need to work on polices to ensure LTC physicians' roles in supporting FCGs and FCGs' roles in LTC are delineated and supported.

Interventions for Family Members After Long-Term Care Placement of a Relative With Dementia: A Systematic Review and Meta-Analysis

The current systematic review aimed to identify, appraise, and synthesize the available evidence regarding interventions that assisted family members of long-term care facility residents with dementia to cope with stressful situations. A search of published articles in eight databases was performed. In total, 1,293 records were identified, with six studies included in this systematic review. Interventions were categorized as education/skill training, psychoeducation, and psychosocial support. The risk of bias across the included studies varied from moderate to high. The intervention components, dose, and delivery methods differed widely with mixed results. The interventions showed potential benefits for reducing family members' stress-related outcomes (e.g., stress appraisal, guilt) and residents' problematic behaviors. Yet, meta-analysis yielded a non-significant pooled effect for reducing family members' depressive symptoms (mean difference = 1.38, 95% confidence interval [-2.27, 5.04], p = 0.46). Evidence in this field is currently insufficient and more well-designed studies with larger sample sizes and use of theoretical frameworks are needed. [Research in Gerontological Nursing, 14(1), 43-52.].

Maintenance of Professional Boundaries and Family Involvement in Residential Aged Care

The importance of family's involvement in care planning has been stressed to cater individualized, person-centered care in residential aged care. However, in reality, there are numerous structural obstacles and barriers that limit opportunities for their involvement. The aim of this article is to explore what they are. The findings based on the 12 focus groups, six groups of care professionals and six groups of family/relatives, reveal that the narrow pathway of communication between staff and families, which is hierarchically structured, one-directional, and clinically driven, enables the former to maintain and control professional boundaries between formal and informal care-giving. Such communication style delimits an opportunity for families to engage in quality discussion about care planning for their loved ones with care staff. Communication within residential aged care facilities embodies complex dynamics of care expectations and responsibilities held by care staff and families.

Using a Flexible Diary Method Rigorously and Sensitively With Family Carers

Health and social science researchers are increasingly interested in the range of new possibilities and benefits associated with diary methods, particularly using digital devices. In this article, we explore how a flexible diary method, which enables participants to choose the device (i.e., paper notebook, tablet, or computer) and medium (i.e., text, photographs, sketches) through which they narrate their experiences, can be used to promote sensitive and rigorous research engagement with family carers to people with dementia. We used a diary interview method with 10 carers over the course of 6 weeks to explore how they experience and interpret the changing behaviors of their cognitively impaired kin. We reflect on how the quality of diary data can be enhanced alongside the ethical dimensions of research with carer populations, through different forms of diary keeping, regular interaction with participants, reflexive practice, and follow-up interviews.