Family carers in stroke care: examining the relationship between problem-solving, depression and general health

Influence of psychological responses of caregiving on the perceived health of family caregivers to acute stroke survivors

Family caregivers provide round-the-clock care to their family members who had a stroke. The detrimental effects of caregiving on caregiver's health would lead to the abandonment of caregiver role and institutionalization of stroke survivors. This study aims to determine the factors associated with the perceived health status of family caregivers to stroke survivors. This study conducted a secondary analysis of the baseline data of 142 family caregivers of stroke survivors nested within a longitudinal randomized controlled trial. Potential factors were identified according to the Pittsburgh Mind-Body Center model and were analyzed with hierarchical multiple regression models. The results indicated that stroke caregivers exhibited comparable perceived physical health with general population but poorer perceived mental health. Severity of depressive symptoms (β = -0.37, P < .001) remained the strongest and most significant factor associated with perceived mental health, followed by confidence in problem-solving (β = -0.21, P < .05). Moreover, caregiving competence (β = 0.29, P < .001) was the sole significant psychological factor associated with perceived physical health. Caregiving competence, problem-solving abilities, and severity of depressive symptoms are significant modifiable correlates of the perceived health of caregivers. Intervention for improving these psychological responses of caregivers is suggested incorporated in stroke rehabilitation programs.

Caregiving Self-efficacy and Knowledge Regarding Patient Positioning Among Malaysian Caregivers of Stroke Patients

Background Most family caregivers of stroke patients in Malaysia do not receive adequate prior preparation or training. This study aimed to determine levels of patient positioning knowledge and caregiving self-efficacy among caregivers of stroke patients. Methods This cross-sectional study was conducted at an urban teaching hospital involving 128 caregivers of stroke patients. The caregivers were conveniently sampled and completed the data collection forms, which comprised their socio-demographic data, patients' functional status, the Caregiving Knowledge For Stroke Questionnaire: Patient Positioning (CKQ-My© Patient Positioning) to measure caregiver's knowledge on patient positioning, and the Family Caregiver Activation Tool (FCAT©) to measure caregivers' self-efficacy in managing the patient. Descriptive and multivariate inferential statistics were used for data analysis. Results Among the caregivers sampled, 87.3% had poor knowledge of positioning (mean score 14.9 ± 4.32). The mean score for FCAT was 49.7 ± 6.0 from a scale of 10 to 60. There was no significant association between knowledge on positioning and self-efficacy. Multiple linear regression showed that caregivers' age (B = 0.146, p = 0.003) and caregiver training (B = 3.302, p = 0.007) were independently associated with caregivers' self-efficacy. Conclusion Caregivers' knowledge on the positioning of stroke patients was poor, despite a fairly good level of self-efficacy. Older caregivers and receiving caregiver training were independently associated with better caregiver self-efficacy. This supports the provision of caregiver training to improve caregiver self-efficacy.

Attitudes and perceptions towards hypoglycaemia in patients with diabetes mellitus: A multinational cross-sectional study

Background

Preventing hypoglycaemia is an essential component of diabetes self-management that is affected by patients’ attitudes and perceptions. This study aimed to explore the hypoglycaemia problem-solving ability of patients who have diabetes mellitus and factors that determine their attitudes and perceptions towards their previous events.

Methodology

A cross-sectional study was conducted between October 2017 and May 2018 in three Arab countries (Jordan, Saudi Arabia and Kuwait) in patients with diabetes mellitus, who were prescribed antidiabetic therapy and had experienced hypoglycaemic events in the past six months. The Hypoglycaemia Problem-Solving Scale was used in this study. This scale contains two subscales, problem orientation (six questions) and problem-solving skills (eighteen questions), using a five-point Likert scale (range 0–4). Multiple linear regression analysis was used to identify predictors of hypoglycaemia problem-solving abilities.

Results

A total of 895 patients participated in this study from the three countries (300 in Jordan, 302 in Saudi Arabia, and 293 in Kuwait). The average age of the patients was 53.5 years (standard deviation = 13.7) and 52.4% (n = 469) were males. Patients had moderate overall problem-solving ability with a median score of 63.00 (interquartile range = 13.00). Patients’ problem-solving skills score (68.1%) was better than their problem-orientation skills score (58.3%). The highest sub-scale scores were for detection control, setting problem-solving goals, and evaluating strategies, 75.0%. The lowest sub-scale score was for problem-solving perception and immediate management, 50.0%. Older age, being educated, being married, having T2DM, prescribed insulin therapy, and not having been admitted to hospital for hypoglycaemia were important predictors of patients’ problem-solving ability (p < 0.05).

Conclusions

Healthcare professionals are advised to provide more education to patients on how to self-manage hypoglycaemic events. Specifically, they should focus on the overall problem-solving perception of hypoglycaemia and its immediate management.

Chinese family caregivers of stroke survivors: Determinants of caregiving burden within the first six months

AIMS AND OBJECTIVES

To describe the family caregivers' caregiving experience for stroke survivors and to identify the determinants of caregiving burden over 6 months.

BACKGROUND

Sociocultural factors influence the caregiving experience in China. However, little is known about the dynamic changes occurring in Chinese caregivers' burden and its determinants.

DESIGN

This is a prospective longitudinal study.

METHODS

A total of 328 participants (164 stroke survivors and 164 family caregivers) from the neurological units of three hospitals in Shiyan were examined during a 6-month period at 1-2 days before discharge (T1) and 3 weeks (T2), 3 months (T3) and 6 months (T4) postdischarge using the Short Portable Mental Status Questionnaire, Multidimensional Scale of Perceived Social Support, Caregiver Strain Index and the Center for Epidemiological Studies-Depression.

RESULTS

Of the 209 dyads recruited, 164 completed all data collection phases, with 69% of the female caregivers aged 56.04 (SD = 4.0; range = 22-80) years. Caregivers reported higher mean burden at T1 (7.35 ± 2.9) but slightly decreased over time at T4 (6.34 ± 3.4), had borderline mean depressive symptoms only in T1 (9.71 ± 3.2) and T2 (9.02 ± 3.8) and had moderate mean social support throughout the 6-month period. Determinants of caregiving burden were stroke survivors' physical dependence, caregivers' age, caring hours per day, depressive symptoms and social support, which explained 46.8%-55.0% of the total variance (p < .05).

CONCLUSION

Caregivers' burden remains a serious problem in the first 6 months. It is an increasing hazard, especially for those at an advanced age who have depressive symptoms and care for severely dependent stroke survivors requiring more caring hours.

RELEVANCE TO CLINICAL PRACTICE

Nurses need to be aware of and understand caregivers' cultural values and beliefs about family obligations when considering an intervention to support them in their role at home.

Effects of a 4-week transitional care programme for discharged stroke survivors in Hong Kong: a randomised controlled trial

Stroke rehabilitation involves care issues concerning the physical, psychosocial and spiritual aspects. Hospital-based rehabilitation has its limitations because many of the care issues only emerge when patients return home. Transitional care models supporting patients after discharge from the hospital have proved to be effective among chronically ill patients, but limited studies were conducted among stroke survivors. This study was a randomised controlled trial conducted to test the effectiveness of a transitional care programme (TCP) which was a nurse-led 4-week programme designed based on the assessment-intervention-evaluation Omaha System framework. Between August 2010 and October 2011, 108 stroke patients who were discharged home, able to communicate, and had slight to moderate neurological deficits and disability were randomised into control (n = 54) and intervention groups (n = 54). Data on the patient-related and clinical outcomes were collected at baseline, 4 weeks when the TCP was completed and 8 weeks after discharge from hospital. Repeated measures analysis of variance with intention-to-treat strategy was used to examine the outcomes. There were significant between-group differences in quality of life, the primary outcome measure of this study, in both physical (F(1, 104) = 10.15, P = 0.002) and mental (F(1, 104) = 8.41, P = 0.005) domains, but only the physical domain achieved a significant time × intervention interaction effect (F(1, 103) = 7.73, P = 0.006). The intervention group had better spiritual-religion-personal measures, higher satisfaction, higher Modified Barthel Index scores and lower depression scores when compared with the control group. They also had lower hospital readmission and use of emergency room rates, but only the use of emergency room had significant difference when compared to control. This study is original in testing a transitional model among stroke patients discharged from hospital. The TCP shares common features that have been proved to be effective when applied to chronically ill patients, and the duration of 4 weeks seems to be adequate to bring about immediate effects.

Informal stroke caregivers' self-appraised problem-solving abilities as a predictor of well-being and perceived social support

AIM

To describe the relationship between self-appraised problem-solving abilities and psychological distress, burden and perceived social support in informal, family stroke caregivers.

BACKGROUND

Previous research suggests that self-appraised problem-solving abilities play a significant role in the well-being of family caregivers of patients with chronic illness. However, little is known about its role in caregivers of stroke survivors.

DESIGN

Prospective correlational study.

METHODS

One week before discharge, 103 family caregivers of survivors of a first stroke were assessed for their perceived problem-solving abilities, social support, anxiety, depression and physical well-being. At three months postdischarge, 85 of these caregivers (83% retention) were reassessed on the same measures. In addition, their levels of burden and perceived difficulties were also measured.

RESULTS

Using multiple regression, overall self-appraised problem-solving abilities and its subscale 'confidence in problem-solving' at one week before discharge were significant predictors of caregiver perceived social support (R(2) = 29%) and perceived physical well-being (R(2) = 42%) at three months postdischarge. Other relationships were non-significant.

CONCLUSIONS

Caregivers' perceived social support and physical well-being were significantly predicted by confidence in problem-solving.

RELEVANCE TO CLINICAL PRACTICE

This study is timely given the challenges facing health systems in Hong Kong to effectively manage chronic illness through family-centred care. The significant relationships between caregiver self-appraised problem-solving, perceived social support and well-being suggest that interventions maximising caregiver confidence in problem-solving might be valuable in supporting family caregivers of stroke survivors. Nurses working with families caring for stroke survivors both close to discharge and in the early transition stages back at home may be in an ideal position to offer this support.

Depression: Problem-solving appraisal and self-rated health among Hong Kong Chinese migrant women

This cross-sectional survey explored the depression status of new migrant women and its relationship with self-rated health in the Hong Kong Chinese context. A convenience sample of 68 migrant women volunteered to participate in the study. The data were collected by using the Problem Solving Inventory, the Center for Epidemiological Studies-Depression questionnaire, and a self-rated health scale. The respondents were found to have a lesser degree of problem-solving appraisal, compared with other populations, and almost half of the volunteers were found to be depressed. Approximately 50% of the women reported their general health as "excellent", "very good", or "good". The Pearson's correlation showed a positive significant correlation between problem-solving appraisal, depression, and self-rated health. The results of the regression analysis showed that family income, self-rated health, and problem-solving confidence are predictive factors of depression. Community nurses could consider using multidisciplinary interventions that focus on life-skills training in order to promote the psychological and general wellness of migrant women in addition to the use of counseling or medication interventions.

Burden among stroke caregivers: results of a community-based study from Kolkata, India

BACKGROUND AND PURPOSE

Stroke causes significant caregiver (CG) stress, which is under-reported in India. This study assesses the financial, physical, psychological, and family burden on CG of stroke patients in an urban community.

METHODS

Cross-sectional survey of stroke patients and CG were selected from a community-based registry using validated scales through face-to-face interviews.

RESULTS

Data were available from 199 stroke survivors and a similar number of CG. Increased workload, related anxiety and depression, and sleep disturbance were reported by 70%, 76%, and 43% of CG, respectively, whereas >80% reported financial worry, which was greater among slum dwellers and less educated families. CG of patients with dementia and depression experienced greater stress. Female CG received more appreciation and family bonding was well-maintained.

CONCLUSIONS

Financial stress was prominent and common among the socioeconomically weaker section. Psychological stress is similar to that of other studies. Women CG received greater appreciation. Family bonding was well-preserved in contrast to that of a western report.

Perceived level of knowledge and difficulty in applying family assessment among senior undergraduate nursing students

Because the structure, development, and functioning of a family plays an important role in health and illness, preparing nursing students to assess families in health care settings is of critical importance. A quasi-experimental design using a pre- and postcourse questionnaire was used to examine students' perceived knowledge about family assessment and perceived difficulty applying family assessment in the clinical setting. The Calgary Family Assessment Model (CFAM) was taught in an elective nursing course, "Families in Health and Illness," offered at the University of Hong Kong. At the completion of the course, 46 senior baccalaureate nursing students showed a significant increase in their perceived understanding of all subcategories in CFAM compared with the control group of 43 senior baccalaureate nursing students who completed an elective nursing course in women's health. Teaching family nursing assessment in undergraduate programs may be useful in ensuring that nurses attend to families in practice.

A review of the information and support needs of family carers of patients with chronic obstructive pulmonary disease

AIMS AND OBJECTIVES

The objectives of this narrative review were to identify: (1) The information and support needs of carers of family members with chronic obstructive pulmonary disease; (2) appropriate interventions to support carers in their caregiving role; (3) information on carers' needs as reported in studies of patients living with COPD in the community.

BACKGROUND

Chronic obstructive pulmonary disease is a major health problem in the UK resulting in significant burden for patients, families and the health service. Current National Health Service policies emphasise, where medically appropriate, early discharge for acute exacerbations, hospital-at-home care and other models of community care to prevent or reduce re-hospitalisations of people with chronic conditions. Understanding carers' needs is important if health care professionals are to support carers in their caregiving role.

DESIGN

A narrative literature review.

METHODS

Thirty five papers were reviewed after searching electronic databases.

RESULTS

Few studies were identified which addressed, even peripherally, carers' needs for information and support, and no studies were found which described and evaluated interventions designed to enhance caregiving capacity. Several studies of hospital-at-home/early discharge, self care and home management programmes were identified which included some information on patients' living arrangements or marital status. However, there was little or no detail reported on the needs of, and in many cases, even the presence of a family carer.

CONCLUSIONS

This review highlights the dearth of information on the needs of carers of chronic obstructive pulmonary disease patients and the need for future research.

RELEVANCE TO CLINICAL PRACTICE

There is little research based knowledge of the needs of carers of chronic obstructive pulmonary disease patients and interventions to assist them in providing care. This knowledge is critical to ensure that carers receive the information they need to carry out this role while maintaining their own physical and emotional health.

Community-based "powerful tools" intervention enhances health of caregivers

Family caregiving is prevalent and may have adverse impacts on health, particularly for elder caregivers who tend to have chronic health conditions which need ongoing self-management. Interventions that empower family caregivers to take care of themselves are needed. This study examined the impact on caregivers of participation in a self-care skill-building, self-efficacy enhancing, community-based program called powerful tools for caregiving (PTC). We assessed health-risk behaviors, self-care, and psychological well-being among 118 adult caregivers who participated in PTC in western Washington state between July 2001 and June 2004, about half of whom were aged 65 or older. Health-risk behaviors were reduced and self-care and psychological well-being improved significantly, overall and for each stratum of age (> or =65 years of age versus <65).