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Lutz BJ, Kucharska-Newton AM, Jones SB, Psioda MA, Gesell SB, Coleman SW, Johnson AM, Radman MD, Levy S, Bettger JP, Freburger JK, Chou A, Celestino J, Rosamond WD, Bushnell CD, Duncan PW. Familial caregiving following stroke: findings from the comprehensive post-acute stroke services (COMPASS) pragmatic cluster-randomized transitional care study. Top Stroke Rehabil 2022; 30:436-447. [PMID: 35603644 DOI: 10.1080/10749357.2022.2077520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Stroke patients discharged home often require prolonged assistance from caregivers. Little is known about the real-world effectiveness of a comprehensive stroke transitional care intervention on relieving caregiver strain. OBJECTIVES To describe the effect of the COMPASS transitional care (COMPASS-TC) intervention on caregiver strain and characterize the types, duration, and intensity of caregiving. METHODS The cluster-randomized COMPASS pragmatic trial evaluated the effectiveness of COMPASS-TC versus usual care with patients with mild stroke and TIA at 40 hospitals in North Carolina, USA. Of 5882 patients enrolled, 4208 (71%) identified a familial caregiver. A follow-up Caregiver Questionnaire, including the Modified Caregiver Strain Index, was administered at approximately three months post-discharge. Demographics and frequency, duration, and intensity of caregiving were compared between groups. RESULTS 1228 caregivers (29%) completed the questionnaire. Completion was positively associated with older patient age, white race, and spousal relationship. One-third of the caregivers provided ≥30 hours of care per week and 889 (79%) provided care ≥9 weeks. Average standardized caregiver strain was 21.9 (0-100), increasing with stroke severity and comorbidity burden. Women caregivers reported higher strain than men. Treatment allocation was not associated with caregiver strain. CONCLUSIONS This sample of mild stroke and TIA survivors received significant assistance from familial caregivers. However, caregiver strain was relatively low. Findings support the importance of familial caregiving in stroke, the continued disproportionate burden on women within the family, and the need for future research on caregiver support.
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Affiliation(s)
- Barbara J. Lutz
- School of Nursing, College of Health and Human Services, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Anna M. Kucharska-Newton
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sara B. Jones
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matthew A. Psioda
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sabina B. Gesell
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sylvia W. Coleman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Anna M. Johnson
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Meghan D Radman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Samantha Levy
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Janet K Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, USA
| | - Aileen Chou
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, USA
| | - Joan Celestino
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Wayne D. Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Cheryl D. Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Pamela W. Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Miller ET, Hinkle JL. Nursing's Contributions to Stroke Care During COVID-19. Stroke 2022; 53:1396-1398. [PMID: 35236089 DOI: 10.1161/strokeaha.122.037447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Janice L Hinkle
- M. Louise Fitzpatrick College of Nursing, Villanova University, Philadelphia, PA (J.L.H.)
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Camicia M, Lutz BJ, Theodore BR. The preparedness assessment for the transition home after stroke predicts key domains of caregiver health. Top Stroke Rehabil 2022; 30:384-392. [PMID: 35156562 DOI: 10.1080/10749357.2022.2038835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Caregivers of stroke survivors often experience adverse health effects due to poor preparation. OBJECTIVES We evaluate the concurrent and predictive validity of the Preparedness Assessment for the Transition Home after Stroke (PATH-s) family caregiver assessment tool relative to important domains of caregiver health and stroke survivor outcomes. METHODS A convenience sample of caregivers (N = 183) was assessed on several health-related quality of life instruments prior to stroke survivor discharge (T1), and at 30-days (T2) and 90-days (T3) post-discharge. RESULTS Caregivers completed assessments at T1 (N = 183), T2 (N = 116, 63%), and T3 (N = 97, 53%). At T1, the PATH-s demonstrated concurrent validity with depressive symptoms (r = -0.26, p < .001), global health (r = 0.45 p < .001) and activation (r = 0.34, p < .001). The PATH-s also has predicted improvements in T2 outcomes including depressive symptoms (radj = -0.21, p < .05), global health (radj = 0.30, p < .01), perceived stress (radj = -0.30, p < .01), activation (radj = 0.21, p < .05), caregiving-specific health-related quality of life (r = 0.23, p < .05), and caregiver strain (r = -0.36, p < .001). At T3, higher scores on the PATH-s were a significant predictor for improvements in activation (radj = 0.24, p < .05). CONCLUSION The PATH-s demonstrates good concurrent and predictive validity and predicts important domains relevant to caregiver well-being. This can be used to identify gaps in caregiver preparedness so interventions can be tailored to optimize the transition home and mitigate adverse effects of caregiving.
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Affiliation(s)
- Michelle Camicia
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo, Vallejo, USA
| | - Barbara J. Lutz
- School of Nursing,University of North Carolina-Wilmington, Wilmington, USA
| | - Brian R. Theodore
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo, Vallejo, USA
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Camicia M, Lutz B, Summers D, Klassman L, Vaughn S. Nursing's Role in Successful Stroke Care Transitions Across the Continuum: From Acute Care Into the Community. Stroke 2021; 52:e794-e805. [PMID: 34727736 DOI: 10.1161/strokeaha.121.033938] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Facilitating successful care transitions across settings is a key nursing competency. Although we have achieved improvements in acute stroke care, similar advances in stroke care transitions in the postacute and return to community phases have lagged far behind. In the current delivery system, care transitions are often ineffective and inefficient resulting in unmet needs and high rates of unnecessary complications and avoidable hospital readmissions. Nurses must use evidence-based approaches to prepare stroke survivors and their family caregivers for postdischarge self-management, rehabilitation, and recovery. The purpose of this article is to provide evidence on the important nursing roles in stroke care and transition management across the care continuum, discuss cross-setting issues in stroke care, and provide recommendations to leverage nursing's impact in optimizing outcomes for stroke survivors and their family unit across the continuum. To optimize nursing's influence in facilitating safe, effective, and efficient care transitions for stroke survivors and their family caregivers across the continuum we have the following recommendations (1) establish a system of coordinated and seamless comprehensive stroke care across the continuum and into the community; (2) implement a stroke nurse liaison role that provides consultant case management for the episode of care across all settings/services for improved consistency, communication and follow-up care; (3) implement a validated caregiver assessment tool to systematically assess gaps in caregiver preparedness and develop a tailored caregiver/family care plan that can be implemented to improve caregiver preparedness; (4) use evidence-based teaching and communication methods to optimize stroke survivor/caregiver learning; and (5) use technology to advance stroke nursing care. Nurses must leverage their substantial influence over the health care delivery system to achieve these improvements in stroke care delivery to improve the health and lives of stroke survivors and their families.
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Affiliation(s)
- Michelle Camicia
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente, Vallejo, CA (M.C.)
| | | | | | - Lynn Klassman
- Advocate Lutheran General Hospital, Park Ridge, IL (L.K.)
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Implementing a Comprehensive Caregiver Assessment and Tailored Family Care Plan Is Essential to a Successful Discharge Home. Rehabil Nurs 2021; 46:297-299. [PMID: 34730899 DOI: 10.1097/rnj.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Camicia M, Lutz BJ, Stram D, Tucker LY, Ray C, Theodore BR. Improving Caregiver Health through Systematic Assessment and a Tailored Plan of Care. West J Nurs Res 2021; 44:307-318. [PMID: 34541990 DOI: 10.1177/01939459211045432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Caregivers often experience strain and negative effects on their well-being. We tested the effects of a caregiver assessment and tailored care plan for caregivers of patients transitioning home from an inpatient rehabilitation facility (IRF), a study involving two groups: usual care (n = 225) (preimplementation) and intervention (postimplementation) (n = 215). Caregivers in the intervention group were assessed using the 25-item self-reported Preparedness Assessment for the Transition Home during the IRF stay. A tailored care plan was implemented in response to the assessment. Caregivers in both groups completed the Modified Caregiver Strain Index and Global Health Scale at 30- and 90-day postdischarge. After adjusting for baseline and demographics, caregivers in the intervention group reported lower strain (p < .01) and better overall health (p < .05) at 30-day post-IRF discharge, relative to usual care. Implementing a systematic caregiver assessment and tailored care plan in the IRF may mitigate the adverse effects of caregiving.
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Affiliation(s)
- Michelle Camicia
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo Medical Center, Vallejo, CA, USA
| | - Barbara J Lutz
- School of Nursing, University of North Carolina-Wilmington, Wilmington, NC, USA
| | - Douglas Stram
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Lue-Yen Tucker
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Cristine Ray
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo Medical Center, Vallejo, CA, USA
| | - Brian R Theodore
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo Medical Center, Vallejo, CA, USA
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Camicia ME, Ann Laslo M, Lutz BJ. Implementing a Caregiver Assessment and Tailored Plan: An Emerging Case Management Competency. Prof Case Manag 2021; 26:205-213. [PMID: 34021107 DOI: 10.1097/ncm.0000000000000513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michelle E Camicia
- Michelle E. Camicia, PhD, RN, CRRN, CCM, NEA-BC, FARN, FAHA, FAAN , is the Director of Operations for Kaiser Foundation Rehabilitation Center. She is an international leader in rehabilitation and nursing, with expertise in care transitions for individuals with chronic and disabling conditions. Dr. Camicia received her PhD from the Betty Irene Moore School of Nursing at the University of California Davis. Her research focuses on health service delivery and assessing and addressing the needs of family caregivers
- Mary Ann Laslo, MSN, RN, CRRN, CCM, CNL, has expertise in care transitions for individuals with chronic and disabling conditions. Her research focuses on health service delivery and assessing and addressing the needs of family caregivers. She is a Clinical Practice Consultant at the Kaiser Foundation Rehabilitation Center in Vallejo, California. She has extensive experience in rehabilitation nursing, case management, and quality, including extensive managerial, organizational, and education/program development capabilities in acute and postacute rehabilitation
- Barbara J. Lutz, PhD, RN, CRRN, PHNA-BC, FAHA, FAAN, is the McNeill Distinguished Professor at the University of North Carolina-Wilmington School of Nursing. Her research focuses on understanding the needs and experiences of patients with chronic disabling illnesses and their family caregivers as they move through the continuum of care, from acute care to home
| | - Mary Ann Laslo
- Michelle E. Camicia, PhD, RN, CRRN, CCM, NEA-BC, FARN, FAHA, FAAN , is the Director of Operations for Kaiser Foundation Rehabilitation Center. She is an international leader in rehabilitation and nursing, with expertise in care transitions for individuals with chronic and disabling conditions. Dr. Camicia received her PhD from the Betty Irene Moore School of Nursing at the University of California Davis. Her research focuses on health service delivery and assessing and addressing the needs of family caregivers
- Mary Ann Laslo, MSN, RN, CRRN, CCM, CNL, has expertise in care transitions for individuals with chronic and disabling conditions. Her research focuses on health service delivery and assessing and addressing the needs of family caregivers. She is a Clinical Practice Consultant at the Kaiser Foundation Rehabilitation Center in Vallejo, California. She has extensive experience in rehabilitation nursing, case management, and quality, including extensive managerial, organizational, and education/program development capabilities in acute and postacute rehabilitation
- Barbara J. Lutz, PhD, RN, CRRN, PHNA-BC, FAHA, FAAN, is the McNeill Distinguished Professor at the University of North Carolina-Wilmington School of Nursing. Her research focuses on understanding the needs and experiences of patients with chronic disabling illnesses and their family caregivers as they move through the continuum of care, from acute care to home
| | - Barbara J Lutz
- Michelle E. Camicia, PhD, RN, CRRN, CCM, NEA-BC, FARN, FAHA, FAAN , is the Director of Operations for Kaiser Foundation Rehabilitation Center. She is an international leader in rehabilitation and nursing, with expertise in care transitions for individuals with chronic and disabling conditions. Dr. Camicia received her PhD from the Betty Irene Moore School of Nursing at the University of California Davis. Her research focuses on health service delivery and assessing and addressing the needs of family caregivers
- Mary Ann Laslo, MSN, RN, CRRN, CCM, CNL, has expertise in care transitions for individuals with chronic and disabling conditions. Her research focuses on health service delivery and assessing and addressing the needs of family caregivers. She is a Clinical Practice Consultant at the Kaiser Foundation Rehabilitation Center in Vallejo, California. She has extensive experience in rehabilitation nursing, case management, and quality, including extensive managerial, organizational, and education/program development capabilities in acute and postacute rehabilitation
- Barbara J. Lutz, PhD, RN, CRRN, PHNA-BC, FAHA, FAAN, is the McNeill Distinguished Professor at the University of North Carolina-Wilmington School of Nursing. Her research focuses on understanding the needs and experiences of patients with chronic disabling illnesses and their family caregivers as they move through the continuum of care, from acute care to home
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