Non-supportive interactions in the experience of women family caregivers

[Social support and quality of life of families with children with congenital heart disease]

The scope of this article is to evaluate to what extent social support for families with children with congenital disease impacts their quality of life. It involved a cross-sectional study with 254 parents of children with congenital heart disease. A semi-structured interview was conducted with the parents, using the Ecomap and the quality of life (World Health Organization Quality of Life Bref) and social support (Medical Outcomes Study) scales. Receiving social support was positively correlated with quality of life (r=0.535; p<0.001). A 10-point increase in the social support scale led to a 3-point increase in the total score of the quality of life scale (β=0.30; CI95%: 0.23; 0.37). Socioeconomic conditions were associated with quality of life (β=0.27; CI95%: 0.11; 0.43) and caregivers who reported not having leisure activity (β=-3.27; CI95% -5.55; -1.12) and who were undergoing health treatment (β=-2.86; CI95%: -5.55; -0.17) had a lower perception of quality of life. Negative consequences to the quality of life of caregivers taking care of a child with congenital heart disease can be intensified by a lack of leisure activity and having health problems. Adequate social support and socioeconomic resources positively influence the quality of life of these caregivers.

Dementia Care in Canada: Nursing Recommendations

Au Canada, la prévention et la prise en charge des démences ont atteint un point tournant. Bien que le taux de diagnostic des démences soit encore bas, le nombre de personnes qui en sont atteintes continue d’augmenter. Les politiques canadiennes en matière de soins de santé ont fait en sorte qu’un plus grand nombre de personnes avec démence vivent à la maison, où les soins sont principalement assurés par la famille, des amis ou des proches. Cette Note de politique présente un aperçu d’un document conjoint de l’Association canadienne des infirmières et infirmiers en gérontologie (AIIG) et de l’Association des infirmières et infirmiers autorisés de l’Ontario (AIIAO) devant le Comité sénatorial permanent des affaires sociales, des sciences et de la technologie. Le document expose le cadre contextuel et les recommandations pour les soins liés à la démence au Canada dans cinq domaines clés : les ressources du système de santé, la formation des prestataires de soins de santé, le logement, les partenaires de soins et l’intégration des soutiens offerts en services sociaux et de santé. Dans le cadre de ces cinq domaines clés, des interventions en matière de santé et de politiques sociales ont été examinées.

Characteristics of the ineffective social support network: integrative review

OBJECTIVE

To evaluate the characteristics of the ineffective social support network evidenced in its structure, functionality and dynamics.

METHOD

Integrative review, carried out in December 2017, in the bases Scopus, CINAHL, Web of Science, CUIDEN, BDENF, Lilacs and SciELO library by means of combinations between keywords/descriptors - Social Network, Social Networks, Social Support, Social Support Networks and the term "ineffective", finding 2012 publications and 24 composed the sample. The analysis of the results was based on the dimensions of the Social Support Network.

RESULTS

In the structural dimension, it was observed characteristics related to the amplitude, density of the network and fragility of the bonds; in the functional, the non-fulfillment of the function of social support in different occasions; and in the dynamics, conflicts and unexpected situations interfered negatively.

CONCLUSION

The evaluation of the characteristics of the ineffective social support network allows a better understanding of their relationships and instrumentalizes nurses in the mobilization of these networks directed to the well-being of the person, family and community.

Applying Risk Society Theory to findings of a scoping review on caregiver safety

Chronic Illness represents a growing concern in the western world and individuals living with chronic illness are primarily managed at home by family caregivers. A scoping review of the home-care literature (2004-2009; updated with review articles from 2010 to January 2013) on the topic of the caregiver revealed that this group experiences the following safety-related concerns: caregivers are conscripted to the role, experience economic hardship, risk being abused as well as abusing, and may well become patients themselves. Methodology and methods used in the scoping review are presented as well as a brief overview of the findings. The concepts of risk and safety are defined. Risk Society Theory is introduced and used as a lens to view the findings, and to contribute to an understanding of the construction of risk in contemporary health-care.

Mothers' lived experiences of support when living with young children with congenital heart defects

PURPOSE

The purpose of this study was to illuminate the meanings of support as disclosed by mothers of children with congenital heart defects (CHD).

DESIGN AND METHOD

Narrative interviews were conducted with 10 mothers of children with CHD. A phenomenological-hermeneutic method was used for interpretation of the transcribed interviews.

RESULTS

The comprehensive understanding of mothers' lived experiences of support emerged as the experiences of receiving good support, receiving "poor support," and absence of support.

PRACTICE IMPLICATIONS

Mothers receiving person-centered and family-centered care feel more supported and are more likely to adapt to the stresses of parenting a child with CHD.

Family members' caregiving situations in palliative home care when sitting service is received: The understanding of multiple realities

OBJECTIVE

To deepen the understanding of the variation of complexity in family members' caregiving situations, when the private home is the place for care, dying, and sitting service.

METHODS

Seven relatives to a deceased family member from four different families were interviewed twice. Data were analyzed by direct interpretation and categorical aggregation.

RESULTS

Various patterns of becoming a caregiver were showed, but family members' willingness to become family caregivers was strongly related to fulfilling the dying persons' wishes to be cared for in their own homes. Important factors for coping with the caregiving situation were their needs of support, the possibility to prepare for death related to a need of communication and planning, the length and predictability of the illness trajectory, and experiences of losses and grief. Sitting service was experienced as supportive for family caregivers when they had possibility to hand over care responsibilities, but as non-supportive when expected help not was received.

SIGNIFICANCE OF THE RESEARCH

Family members' experiences of caregiving and their degree of vulnerability must be different, depending on whether it is a self-selected position or an imposed task. In general, family members in this study were willing to participate in caregiving for end-of life care, but subject to their own conditions. One way to decrease vulnerability is to assess the resources and competence in relation to the responsibility the person is expected to assume. The support and other efforts to help family caregivers must be related to their specific needs and reality, not only to what the care organization can offer as a standard solution.

Parenting children living with type 1 diabetes: a qualitative study

PURPOSE

The purpose of the study was to explore a parent's sense of meaning in relation to the parenting of a child with type 1 diabetes.

METHODS

A qualitative collective case study design was used and 10 interviews conducted with parents of children with type 1 diabetes. Recruitment took place through the Winnipeg Diabetes Education and Resource for Children and Adolescents and Juvenile Diabetes Research Foundation. Categories were identified using qualitative content analysis.

FINDINGS

Two major categories identified include being like everyone else and protecting the children.

IMPLICATIONS

Findings indicate that there is a need for greater diabetes education in schools. Diabetes educators can play a more proactive role in leading school based discussions with children, parents, and school staff.

Supportive care to family caregivers is not supportive enough: moving towards an equitable approach to dementia home care

SUMMARY The current relationship between family caregivers and home care providers needs to be reconceptualized from one that is nonsupportive and potentially exploitive, to one that fosters a collaborative, empowering relationship. I present my argument in three parts. First, I focus on the problem of the current complementary model of care, one in which home care workers supplement and compensate for the care provided by family caregivers. In effect, I outline how this model of dementia home care in Canada perpetuates an inequitable distribution of care between formal and familial caregivers. Here, I underscore the negative consequences of this complementary approach on the caregiver–provider relationship. In the second part, I call for a reappraisal of ‘supportive relationships’ between home support workers and caregivers, identifying underlying values and principles (e.g., quity) that I believe should inform home care practices and policies in the future. Finally, I propose some possible strategies that may ultimately support both family caregivers and providers in promoting optimal dementia home care.

Dementia home care resources: how are we managing?

With the number of people living with dementia expected to more than double within the next 25 years, the demand for dementia home care services will increase. In this critical ethnographic study, we drew upon interview and participant data with persons with dementia, family caregivers, in-home providers, and case managers in nine dementia care networks to examine the management of dementia home care resources. Three interrelated, dialectical themes were identified: (1) finite formal care-inexhaustible familial care, (2) accessible resources rhetoric-Iinaccessible resources reality, and (3) diminishing care resources-increasing care needs. The development of policies and practices that provide available, accessible, and appropriate resources, ensuring equitable, not necessarily equal, distribution of dementia care resources is required if we are to meet the goal of aging in place now and in the future.

Evaluation of an elderly care training programme for women

BACKGROUND

Caregiving across different cultures has been perceived conventionally as a private or family responsibility, predominantly performed by women who accept their caregiving as part of their gender role.

AIM

This study aimed to design, deliver, and evaluate an elderly training programme for women by assessing their knowledge, attitudes and skills as a lay caregiver. Encouraging the women to find suitable positions for employment in private or governmental institutions was the further objective of the study.

DESIGN

The study was a quasi-experimental one-group pre-test post-test design.

METHODS

The study was conducted in a solidarity centre for women and in a nursing home for the elderly. The sample covered 120 women selected from the community by convenience sampling. Data were gathered through pre- and post-test evaluation and observation forms in 2 May-22 December 2005. The training programme consisted of 230 h of didactic sessions, demonstrations and clinical practices.

FINDINGS

The mean change in the participants' knowledge score (pre-test: 41.44 +/- 0.92; post-test: 71.16 +/- 1.34) demonstrated a statistically significant improvement in their knowledge. According to clinical observations, most of them displayed satisfactory caring and communication skills towards the elderly. Virtually all participants reported increased skill, knowledge and confidence.

CONCLUSION

The developed training programme was effective, resulting in an increased knowledge, the acquisition of good attitudes towards the elderly, and performing satisfactory caring and communication skills. Similar community-based programmes managed by nurses are recommended to support non-professional caregivers. The research is not only an innovative but also a revolutionary model to promote women.

The role of attitudes and culture in family caregiving for older adults

This study evaluated cultural differences in attitudes toward caregiving and the stress levels of family caregivers. Participants included 98 Japanese American and 86 Caucasian American family caregivers caring for frail elders. Analyses using MANOVA and multiple regression analyses revealed that the Caucasian caregivers had more positive attitudes and provided more hours of care than the Japanese caregivers but that both groups had elevated levels of caregiver stress. The stress that family caregivers currently experience could lead to a future generation of care recipients who enter old age in worse condition than their predecessors. Professionals need to work together to develop culturally appropriate, evidence-based interventions to address this issue.

Formal care providers' perceptions of home- and community-based services: informing dementia care quality

Little attention has been given to the perceptions of formal care providers on the nature and quality of home- and community-based dementia care. The purpose of this descriptive interpretive research was to explore formal care providers' perceptions of their experiences with Canadian home- and community-based dementia care. Participants within three personal interviews and six focus groups (n = 41) included nurses, social workers, therapists, home care aides, and Alzheimer Society personnel (front line/management) in rural and urban areas of Saskatchewan (n = 16), Manitoba (n = 20), and Ontario (n = 8). Two overarching thematic categories, Service Availability and Service Acceptability, emerged from the data analysis. Subthemes of availability were identified as: (a) challenges of service availability, including service wait lists, lack of home care provider training, lack of community-based dementia care infrastructure, and sociocultural and geographic barriers to accessing dementia services; and (b) essential facilitators of availability, including service infrastructure, service bridging, and agency partnerships to form coordinated care systems. Subthemes of acceptability were revealed as: (a) essential components of dementia care, including provision of comprehensive personal care and the use of dementia care professional practice knowledge within a home care setting; and (b) service challenges, including inadequate service time for the physical care and socioemotional support of the client and family caregiver, caregiver and formal provider difficulty with navigation of a fragmented care system, lack of system coordination, and financial costs of services. Essential, integrated dementia care could be established by listening to the "voices of formal care providers," thereby decreasing dementia care costs and increasing the quality of life for those with dementia, and their family caregivers.

Men family caregivers' experience of nonsupportive interactions: context and expectations

Men's involvement as family caregivers has grown as the prevalence of dementia has increased. Men rely on support from others for caregiving but also experience nonsupportive interactions. The purpose of this ethnographic study of 34 men (24 spouses and 10 sons) caring for a relative with dementia, 5 assisting caregivers, and 15 professionals was to identify primary caregivers' perceptions of nonsupportive and supportive interactions in relationships with kin and friends as well as professionals. Thematic analysis of transcribed data generated from interviews, diaries, and focus group discussions revealed the nature of men's caregiving journeys, the characteristics of their social networks, and their expectations of supportive interactions. The nonsupportive interactions men caregivers experienced included a lack of orientation to the caregiving situation, an unsatisfactory linkage to support sources, insufficient support, and hurtful interactions. Information about nonsupportive interactions can sensitize kin and friends as well as professionals to the complexity of men's experience and potentially avoid unintended negative consequences of support efforts.

'It's the system working for the system': carers' experiences of learning disability services in Ireland

The aim of this article is to examine the experiences of families with young adults with learning disabilities trying to access services. The landscape of disability services for this group is made up of day care, special vocational training and respite places. It aims to identify the extent of an implementation gap between government rhetoric and the degree to which services are characterised as being non-supportive interactions on the ground. Using Ireland as a case study, during a time when the economy is booming and government rhetoric claims unparalleled developments in allocating resources and extra respite 'places', this article identifies the main challenges faced by family carers associated with accessing appropriate services for their disabled adult child, in their attempt to achieve greater independence. This article reports the findings of a qualitative study in which individual semistructured interviews were held with family carers (n = 25) and representatives from national carer organisations (n = 6) in Ireland. These were people caring for an adult (18-30 years) with a learning disability and their experiences were also useful in cross-checking the carer organisation interviews. The findings show that there is limited flexibility, choice and availability in meeting the preferences of the service-users, and throughout the study, services were characterised as being non-supportive interactions. This is not simply symptomatic of a lack of resources. Despite improved funding, supportive attitudes and flexibility are still crucial in meeting user requirements at the level of delivery; thus highlighting that often the system works for the system, not for the user.

Caregivers' experiences with major depression concealed by physical illness in patients recruited from central Ugandan Primary Health Care Centers

In this article, we present caregivers' grapples with major depression seen among their physically ill patients. A thematic analysis of 29 in-depth caregiver interviews identified four themes: (a) caregivers' perceptions of depression, (b) barriers to caregivers' focus on depression, (c) resources and opportunities for managing depression, and (d) caregivers' perspectives on consequences of depression. Patients' physical illnesses concealed depressive episodes. Caregivers could not apply the label of "depression" but enumerated its indicative features. Stigmatization of depression, common with other mental illnesses and poverty, undermined caregiving. Vital caregiving resources included caregivers' willingness to meet patients' basic needs, facilitating patients' access to health care, informal counseling of patients, and ensuring patients' spiritual nourishment. Caregivers' management of depression in physically ill patients was expensive, but they coped; however, caregiving was burdensome. Ongoing support should be given not only to patients but caregivers, as well. To provide appropriate care, caregivers deserve sensitization about depression in the context of physical illness.