"Stuck in a loop of fear": a phenomenological exploration of carers' experiences supporting a spouse with acquired brain injury

Burden in caregivers of patients with acquired brain injury: Influence of family role and gender

BACKGROUND

Acquired brain injuries (ABI) represent neurological disorders that can arise after traumatic and non-traumatic events. In addition to the physical, emotional and cognitive challenges that patients face, these injuries can bring changes in the life of the patient and his or her family.

OBJECTIVE

This study aims to understand how the occurrence of an ABI condition can disrupt and reshape family functioning by examining certain dimensions such as role in the family, gender and age, which may have a major influence on family dynamics.

METHODS

We enrolled 86 caregivers of patients with ABI. Two experienced psychologists examined family functioning with Olso's Family Adaptability and Cohesion Rating Scale (FACES IV).

RESULTS

The correlation between groups by generics showed a significant difference only for flexibility (p = 0.05). Specifically, flexibility was greater in male caregivers, particularly in sons. Most of the constructs defining family functioning, such as communication, remained unchanged despite the ABI event.

CONCLUSION

This study provides an in-depth understanding of how families face the challenges posed by the ABI and the role caregivers play within the system.

Patient and Caregiver Satisfaction With the Brain Injury Rehabilitation: Improving the Transition Experience (BRITE) Intervention

OBJECTIVE

To ascertain patient and caregiver satisfaction with an individualized case management intervention to improve transition from inpatient rehabilitation care to the community after traumatic brain injury (TBI).

SETTING

Participants from 6 National Institute on Disability, Independent Living, and Rehabilitation Research-funded TBI Model Systems sites in the United States.

PARTICIPANTS

Adult, English-speaking patients with TBI who had moderate-to-severe TBI and were discharged from a TBI Model Systems site and who were in the intervention arm of the Brain Injury Rehabilitation: Improving the Transition Experience pragmatic clinical trial, as well as their caregivers.

DESIGN

A survey of participants in the intervention arm, which included an individualized case management program administered by a TBI Care Manager (TCM) who facilitated resource connection, education, and support.

MAIN MEASURES

Satisfaction with intervention was measured through Likert-scaled and open-ended questions. The survey was administered verbally through telephone, audio-recorded, and transcribed. Descriptive statistics were calculated for categorical variables, and content analysis was conducted for open-ended responses.

RESULTS

Patient and caregiver participants were satisfied with the intervention and highlighted the benefits of the interpersonal and practical support provided by the TCM. Participants identified the need for a more intensive intervention and clear expectations of the TCM role, as well as gaps in available medical and rehabilitation services in the community, as areas for improvement.

CONCLUSION

Patients with TBI and their caregivers reported satisfaction with the individualized case management program in supporting their transition from inpatient rehabilitation to the community. Further research is needed to understand the impact on outcomes.

"It gave her that soft landing": Consumer perspectives on a transitional rehabilitation service for adults with acquired brain injury

Transitional rehabilitation service models for people with acquired brain injury (ABI) may address sub-optimal support for individuals returning home after hospitalization for ABI. This study investigated perspectives of people with ABI and close others who received transitional rehabilitation. A qualitative study involving semi-structured interviews with 10 individuals with ABI and 12 associated close others was conducted as part of a mixed-method evaluation of an Australian transitional rehabilitation service (TRS) pilot project. Thematic analysis based on the Framework method was conducted independently by two researchers. Three broad themes illustrated participants' experience of the TRS: (1) structure after hospital discharge; (2) a "soft landing"; and (3) equipped for community living. Findings suggest that home-based, interdisciplinary transitional rehabilitation after hospital discharge was perceived as an important stage of rehabilitation by participants. Valued features relate to post-hospital rehabilitation structure: a single point of contact to facilitate organization and information exchange, a known discharge destination, and consistent communication; support and therapy within a familiar home environment; and being equipped with relevant knowledge and strategies to manage ongoing challenges. Further research exploring the experiences of individuals with ABI without close family or social support, and research capturing longitudinal outcomes from transitional rehabilitation is recommended.

Experiences of acquired brain injury one-month post-discharge from acute hospitalisation

Background

Healthcare professionals may have a preconceived idea about life after an acquired brain injury (ABI). Understanding lived experiences of individuals with ABI and their significant others, post-hospitalisation, may improve communication between healthcare professionals and individuals directly influenced by the ABI.

Objective

To describe perceived experiences of individuals with ABI, and their significant others, regarding rehabilitation services and returning to daily activities, one-month post-discharge from acute hospitalisation.

Method

Semi-structured interviews, via an online platform, expanded on the experiences of six dyads (individuals with an ABI and their significant others). Data were thematically analysed.

Results

Six main themes emerged that best described participants' experiences; two of which were shared between individuals with ABI and their significant others (SO). Individuals with an ABI acknowledged recovery as their priority and highlighted the importance of patience. The need for counselling and additional support from healthcare professionals and peers arose. The SO expressed a need for written information, improved communication from healthcare professionals, and education regarding the implications of an ABI. The coronavirus disease 2019 (COVID-19) pandemic negatively influenced all participants' overall experiences, mainly because of termination of visiting hours. Psychosocial intervention would have been beneficial to all participants. Faith influenced most participants' attitudes towards recovery and adapting post-ABI.

Conclusion

Most participants accepted their new reality but required additional support to cope emotionally. Individuals with an ABI would benefit from opportunities to share experiences with and learn from others in a similar situation. Streamlined services and improved communication may alleviate anxiety among families during this crucial transitional period.

Contribution

This article provides valuable information on the perspectives and experiences of individuals with ABI and their significant others during the transition from acute hospitalisation. The findings can assist with the continuity of care, integrative health and supportive strategies during the transition period post-ABI.

Training on Emotional Intelligence for Caregivers of Patients with Acquired Brain Injury and Cognitive Impairment: A Quasi-Experimental Study

BACKGROUND

Cognitive-behavioral alterations can occur after an acquired brain injury (ABI).

OBJECTIVES

To develop and evaluate a synchronous online training program on emotional intelligence (EI) for the caregivers of adult patients with cognitive-behavioral impairment due to ABI.

METHODS

Quasi-experimental study. Ten caregivers attended a one-month virtual synchronous course about EI. The emotional status of the caregivers was registered one-month-previous and one-month-post program using comparative measures: The Trait Meta-Mood Scale (TMMS-24), the Positive and Negative Affect Schedule (PANAS), Caregiver Burden Interview, the 10-item Connor-Davidson Resilience Scale, and the Emotional Health Survey.

RESULTS

After the training course, the favorable changes related to emotional affect measured with the PANAS questionnaire were found; both positive (increase; Mdn = 39.5; effect size -12.79; adjusted variance 95.75) and negative (decrease; Mdn = 14.5; effect size 0.73; adjusted variance 95.50) presented a statistical significance of p < 0.05. The TMMS-24 post-test showed that 90% of the caregivers reported an adequate or excellent emotional repair (p < 0.05; effect size -0.68; adjusted variance 94.75). No other significant differences were found.

CONCLUSIONS

After this training in EI, the caregivers had a more positive mood and improved aspects of their emotional intelligence, such as emotional regulation. More studies need to be conducted.

Pictures and a thousand words: the experiences of significant others whose loved ones have a severe brain injury who are being discharged home

Purpose:

To investigate the experiences of significant others when their loved one with a severe acquired brain injury (ABI) is being discharged from an ABI-specific rehabilitation unit.

Participants:

Significant others of loved ones with an ABI participated in interviews close to their loved ones being discharged from inpatient ABI rehabilitation.

Methods:

Semi-structured interviews were conducted, and thematic analysis applied. Additionally, the drawing method was also used which involved participants drawing what it was like for them as their loved one was going home. Image analysis was then combined with the interview data.

Results:

Eight significant others participated in interviews on discharge and completed a drawing describing their experience. Five themes were identified (Change, Mixed feelings, Support of family and friends, Journey and Staff interactions).

Conclusion:

The experience of having a loved one with a severe ABI in rehabilitation is an emotional event. Compassionate communication, consistency of information and thorough discharge planning practices were cornerstones to enhancing the experience of significant others, empowering them to undertake their new role.

Acceptance, grief and adaptation amongst caregivers of partners with acquired brain injury: an interpretative phenomenological enquiry

PURPOSE

Families provide vital support to relatives with brain injury yet shoulder significant stress and anxiety with little help threatening family cohesion and rehabilitative outcomes. This paper analyses the accounts of people caring for a long-term partner with brain injury to identify coping mechanisms and support systems that enhanced well-being. Materials and method: This study used semi-structured interviews with eight participants and interpretative phenomenological analysis. Results: Three themes are reported-"moving through denial toward acceptance"; "confronting and managing ambiguous loss"; and "becoming an expert carer". Theme one describes participants' struggles to accept the longevity of brain injury and use of strenuous care practices to deny or fight disability; this proved counterproductive and was later remedied by individuals embracing change and making adaptations. Theme two reports how participants split their partners' identities -before and after brain injury- to help grieve for the marital relationships they lost. Theme three looks at participants' development of self-reliant attitudes to caregiving due to perceived limited state help, while embracing peer support that enhanced information and emotion-based coping. Conclusions: Findings support therapeutic practices that help family members confront the permanence of brain injury, and target feelings of complex and unresolved grief. Future research proposals are discussed.IMPLICATIONS FOR REHABILITATION:Caregivers typically provide considerable rehabilitative support to spouses living with Acquired Brain Injury to manage the physical and psychosocial burdens of long-term disability.Therapeutic interventions should reconcile notions of hope and acceptance in order to help carers confront the permanence of brain injury and develop sustainable care practices.We recommend that interventions address feelings of unresolved grief and ambiguous loss and develop tailored support for caregivers which targets pertinent psychological concerns.

Informal Caregiver Burnout? Development of a Theoretical Framework to Understand the Impact of Caregiving

Informal caregiving is a rewarding but demanding role. The present theoretical framework proposes to adapt the tridimensional concept of burnout to informal caregiving as a way to address the potential consequences of caregiving. This adaptation reflects caregivers' reported difficulties, as well as empirical findings on emotional exhaustion, depersonalization, and personal accomplishment as caregiving outcomes. But to understand burnout in informal caregiving contexts, it is also necessary to find ways to model it. The Informal Caregiving Integrative Model (ICIM) is thus proposed. This model is based on the integration of elements from literature on both informal caregiving stress and professional burnout. The goal of the ICIM is to emphasize the importance of every category of determinants of informal caregiver burnout (i.e., relating to the caregiver, the caregiving setting, and the sociocultural context), with a key mediating role for the caregivers' appraisal of their situation and their relationship with the care-recipient. This article is a first integrative step in the consideration of a form of burnout specific to informal caregivers and supports the design of empirical and interventional studies based on the theoretical foundation that the ICIM proposes.