The relationship between caregiver's strain and social support among mothers with intellectually disabled children

Psychosocial impacts of caring for a child with a genetic disorder in Accra, Ghana

Caregivers caring for a child with a genetic condition may experience psychosocial distress, which may be compounded by the context in which the caring takes place. Few studies have examined psychosocial distress and support among caregivers caring for a child with a genetic disorder in low-middle-income countries such as Ghana. The purpose of the current study was to investigate the psychosocial impacts of caring for a child with a genetic disorder in an urban setting in Ghana's capital, Accra. We conducted individual interviews among 17 caregivers who were taking care of children with various genetic disorders including, albinism, Edward's syndrome, osteogenesis imperfecta, sickle cell disease, and spondyloepiphyseal dysplasia congenita. Thematic analysis of the data revealed three main themes on the psychosocial impacts, including: (1) self-blame, guilt, and shame; (2) sleep and mood disturbances; and (3) discrimination and stigmatization. We observed three themes about support: (1) psychological support; (2) family and community support; and (3) institutional support. Participants reported limited support from professionals such as psychologists. Discussion focuses on the supportive care needs of caregivers and implications for genetic counselling awareness, advocacy, and training.

Protocol for a mixed-methods randomised controlled trial evaluating the effectiveness of a dyadic expressive arts-based intervention in improving the psychosocial well-being of children with intellectual disability in special schools and their mothers

INTRODUCTION

Mothers of children with intellectual disability (ID) are often distressed because of intensive workloads and difficulties in communicating with their children. Given the interdependence between the psychosocial well-being of such dyads, interventions that promote parent-child relationships and mutual communication would be beneficial. Arts provide alternative avenues for expression and offer an imaginative and playful environment for discovering new communication strategies. Given the lack of studies on arts-based dyadic interventions, this study aims to examine the effectiveness of dyadic expressive arts-based intervention (EXAT) in improving the psychosocial outcomes of children with ID and their mothers and the mother-child relationships.

METHODS AND ANALYSIS

This study will adopt a mixed-methods randomised controlled trial design, wherein 154 dyads of children with ID and their mothers will be randomised into either the dyadic EXAT group or the treatment-as-usual waitlist control group. Quantitative data will be collected at four time points: baseline (T0), postintervention (T1), 3-month postintervention (T2) and 6-month postintervention (T3). Qualitative data will be collected from a subset of 30 mothers in the intervention group at T1 and T3 to document their experiences and perceived changes after the intervention. Mixed-effects models and path analysis will be adopted to analyse the quantitative data, whereas thematic analysis will be applied to the qualitative data. Both sets of data will be triangulated for an integrated view of the effectiveness and mechanism of the intervention.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Human Research Ethics Committee of the University of Hong Kong (Ref. no.: EA200329). Written consent forms will be obtained from all recruited participants (mothers, children with ID and teachers/social workers) before data collection. The study findings will be disseminated in international conferences and peer-reviewed academic journals.

TRIAL REGISTRATION NUMBER

NCT05214859.

The Spiritual and Religious Coping of Mothers with Disabled Children in Turkey: Correlation Between Stress Coping Styles and Self-Efficacy

This study aimed to determine the correlation between stress coping styles and self-efficacy with regard to the spiritual and religious coping of mothers with disabled children. The descriptive and relational screening model was used in this study. The research was completed with 227 mothers in a private rehabilitation center at Turkey. The data were collected using Maternal Spiritual Coping, Religious Coping Styles, Stress Coping Styles Scales (SCSS), and General Self-Efficacy Scales. As a result of the study, there was a statistically advanced degree of significant correlation in a positive direction between effective coping with stress and spiritual coping (p < 0.001), and a negative significant correlation between ineffective coping with stress and general self-efficacy (p < 0.05). Additionally, there was a negative significant correlation between the SCSS-effective coping dimension with the SCSS-ineffective coping points (p < 0.05). The high level of spiritual coping of mothers and its effect on coping with stress is an important result. For the participation of children with disabilities and their parents in society, it is essential to identify components such as mental health and spiritual coping that will improve mothers' mental health so that mothers can effectively cope with the difficulties they experience.

Parenting in Cerebral Palsy: Understanding the Perceived Challenges and Needs Faced by Parents of Elementary School Children

Cerebral palsy (CP) can be considered the most frequent childhood physical disorder. The severity and type of dysfunction depend on the brain injury. Movement and posture are the most affected areas. CP is a lifelong condition, and parenting a child with this disorder brings additional challenges (e.g., dealing with grief) and needs (e.g., information). Identifying and characterizing their challenges and needs are pivotal to enrich the knowledge in this field and help draw more suitable support for parents. Interviews with 11 parents of children with CP attending elementary school were conducted. The discourse was transcribed, and a thematic analysis was performed. Three themes emerged from the data: (i) challenges of parenting a child with CP (e.g., internal challenges), (ii) crucial needs for parents to cope with a child with CP (e.g., information), and (iii) the intersection between challenges and needs of parents of children with CP (e.g., unawareness). Regarding the challenges and needs characterization, lifespan was the most frequent period of child development, and the microsystem was the context of life most reported. The findings may inform the design of educational and remediation interventions to support families of children with CP attending elementary school.

Challenges and support needs of parents of children with developmental disabilities (DD) in Accra, Ghana

BACKGROUND

Parents of children with developmental disabilities (DD) have diverse challenges and needs. If met, these parents are able to provide adequate care for their children. Unfulfilled needs like information about their child's diagnosis, counselling, and poor access to informal and formal supports increase parental stress and hinder their potential to provide optimal care for their children and themselves.

AIMS

This study explores the unique challenges and needs of parents caring for children with DD in the Accra metropolis. This is the first study exploring the needs of parents in a Lower-middle income (LMIC) country like Ghana.

METHODS AND PROCEDURES

A qualitative research design was adopted for this study. Data was collected using semi-structured interviews from 9 parents of children with DD.

RESULTS

Findings from thematic analysis revealed five themes including; Emotional needs; Informational needs; Financial needs; Informal Support, and Formalized Support. Parents indicated their great need for information on their children's condition, support from family, religious groups, and other formalized institutions and how to provide better care.

CONCLUSIONS AND IMPLICATIONS

Parents have several expectations and needs which must be addressed. Findings have the potential of influencing the design and development of appropriate interventions to meet the needs and improve the quality of life of parents of children with DD in the Ghanaian context.

The experiences of mothers of children and young people with intellectual disabilities during the first COVID-19 lockdown period

BACKGROUND

Recent COVID-19 lockdown restrictions resulted in reduced access to educational, professional and social support systems for children with intellectual disabilities and their carers.

AIM

The aim of this study was to gain insight into the ways mothers of children with intellectual disabilities coped during the first 2020 lockdown period.

METHODS

Eight mothers of children with intellectual disabilities were interviewed. The recordings of these interviews were subjected to a thematic analysis.

RESULTS

Three main themes were identified: carrying the burden; a time of stress; and embracing change and looking to the future.

CONCLUSIONS

All mothers experienced increased burden and stress. However, some also described some positive impact of lockdown conditions on them as well as on their child's well-being and behaviour. These findings are discussed in the light of the (Journal of Applied Research in Intellectual Disabilities, 33, 2020, 1523) survey results on parental coping and suggestions for future service provision during pandemic conditions are proposed.

Attitudes promoting coping with death anxiety among parents of children with disabilities

We investigated death anxiety among parents of children with disabilities and its associations with coping attitudes and psycho-demographic factors. Surveys were administered to 382 parents of children who possess a severe disability and data were analyzed via descriptive and inferential statistics. Findings revealed that parents experienced high levels of death anxiety; the level of death anxiety changed according to some psycho-demographic factors, such as external support, type of disability, and death-related beliefs; and death anxiety was significantly explained by demographic variables, death-related thoughts, and experiences, and adaptive and maladaptive coping attitudes.

Priority concerns for people with intellectual and developmental disabilities during the COVID-19 pandemic

BACKGROUND

The approach taken to support individuals during the coronavirus disease 2019 (COVID-19) pandemic needs to take into account the requirements of people with intellectual disabilities and/or autism, who represent a major vulnerable group, with higher rates of co-occurring health conditions and a greater risk of dying prematurely. To date, little evidence on COVID-related concerns have been produced and no report has provided structured feedback from the point of view of people with intellectual disabilities and/or autism or of their family/carers.

AIMS

To provide systemised evidence-based information of the priority concerns for people with intellectual disabilities and/or autism regarding the COVID-19 pandemic.

METHOD

Senior representatives of major UK-based professional and service-user representative organisations with a stake in the care of people with intellectual disabilities and/or autism were contacted to provide a list of concerns across three domains: 'mental health and challenging behaviour', 'physical health and epilepsy' and 'social circumstances and support'. The feedback was developed into statements on frequently reported priorities. These statements were then rated independently by expert clinicians. A video-conference meeting to reconcile outliers and to generate a consensus statement list was held.

RESULTS

Thirty-two organisations were contacted, of which 26 (81%) replied. From the respondent's data, 30 draft consensus statements were generated. Following expert clinician review, there was initially strong consensus for seven statements (23%), increasing to 27 statements (90%) following video conferencing.

CONCLUSIONS

These recommendations highlight the expectations of people with intellectual disabilities and/or autism in the current pandemic. This could support policymakers and professionals' deliver and evidence person-centred care.

Information Requirements and Sources of Families of Mainstreaming Students Elementary Education Model in Respect of Socioeconomic Development Levels

Aim

This research was conducted to reveal the current situation on information requirements of the families of the mainstreaming students and sources they obtained information.

Method

The research is a cross-sectional study and the population consisted of parents whose children need special education and who are in schools located in Altındağ, Yenimahalle, and Çankaya districts of Ankara, which are at low, middle, and high levels, respectively, according to the socioeconomic development. Sample selection was not made. A survey was distributed to 1,151 families of the mainstreaming students in 72 elementary schools in the selected districts, and 404 questionnaires that had been returned were evaluated. A questionnaire developed by the researchers was used as the data collection form.

Results

A total of 75.1% of families are mothers and 24.9% are fathers. In total, 26.5% of families stated that they did not have sufficient information about the diagnosis of their child, 64.2% of the families stated that they want to be informed about adaptation to school life, 25.1% about daily life activities, nutrition, and care skills, and 48.2% of families stated that they are not in cooperation with health care professionals, whereas 57.8% of the families who have sufficient information about the diagnosis of the child are in cooperation with health care professionals; this rate was found to be 31.4% in those who do not have information. Among the health care professionals, where families receive information about the diagnosis of the child, physicians are the most frequently received occupational group, with 82.3%. The rate of receiving information from nurses was found to be 3.4%.

Conclusion

Families of mainstreaming students have need for information regarding the diagnosis of the child. The nurse group has a very low rate among the sources they get information from. It can be said that families do not cooperate adequately with health care professionals.

Mental health and well-being of fathers of children with intellectual disabilities: systematic review and meta-analysis

BACKGROUND

Caring for a child with intellectual disabilities can be a very rewarding but demanding experience. Research in this area has primarily focused on mothers, with relatively little attention given to the mental health of fathers.

AIMS

The purpose of this review was to summarise the evidence related to the mental health of fathers compared with mothers, and with fathers in the general population.

METHOD

A meta-analysis was undertaken of all studies published by 1 July 2018 in Medline, PsycINFO, CINAHL and EMBASE, using terms on intellectual disabilities, mental health and father carers. Papers were selected based on pre-defined inclusion and exclusion criteria.

RESULTS

Of 5544 results, 20 studies met the inclusion criteria and 12 had appropriate data for meta-analysis. For comparisons of fathers with mothers, mothers were significantly more likely to have poor general mental health and well-being (standardised mean difference (SMD) -0.38, 95% CI -0.56 to -0.20), as well as higher levels of depression (SMD, -0.46; 95% CI -0.68 to -0.24), stress (SMD, -0.32; 95% CI -0.46 to -0.19) and anxiety (SMD, -0.30; 95% CI -0.50 to -0.10).

CONCLUSIONS

There is a significant difference between the mental health of father and mother carers, with fathers less likely to exhibit poor mental health. However, this is based on a small number of studies. More data is needed to determine whether the general mental health and anxiety of father carers of a child with intellectual disabilities differs from fathers in the general population.

Parental quality of life: caring for an infant or toddler with a tracheostomy at home

PURPOSE

To explore the relationships between stress, coping, duration of tracheostomy, and quality of life (QOL) of parental caregivers who care for a child with a tracheostomy at home.

DESIGN

A cross-sectional correlational design was used to study parents who care for a child with a tracheostomy at home. Family Inventory of Life Events, Family Crisis Oriented Personal Evaluation Scale, and Psychological General Well-Being Index were used to measure stress, coping, and QOL, respectively. Data were collected using both online and paper-pencil format.

MAIN OUTCOME VARIABLE

quality of life.

RESULTS

Parents who care for their infants/toddlers with a tracheostomy at home were found to be in moderate distress. Mean age of the participants was 33 years (N = 71), and the average duration of the child's tracheotomy was 18.22 (SD = 9.59) months. Multivariate analysis showed a significant inverse relationship between QOL and stress. QOL was significantly associated with coping, B = 19.91, β = .43, p <.001.

The relationship between family functioning and caregiving appraisal of dementia family caregivers: caregiving self-efficacy as a mediator

OBJECTIVES

The aim of this study was to explore caregiving self-efficacy as a mediator for the association between family functioning and caregiving appraisal of dementia family caregivers in Taiwan.

METHOD

This study adopted a cross-sectional correlational design. Purposive sampling was used to recruit 115 dyads of dementia patients and family caregivers from the outpatient neurological clinics of two hospitals in northern Taiwan. Data were gathered through interviews with a structured questionnaire, which included demographic characteristics for caregivers and patients, family functioning, caregiving self-efficacy, as well as positive and negative aspects of caregiving appraisal.

RESULTS

Family functioning, patients' activities of daily living score, Neuropsychiatric Inventory caregiver distress, and three domains of self-efficacy were significantly associated with caregiver burden. Hierarchical multiple regression analyses indicated that self-efficacy for obtaining respite (SE-OR) significantly explained 20.5% of the variance in caregiver esteem. Caregiver perceived worsened health status, family functioning, and SE-OR significantly explained 59% of the variance in caregiver burden. The mediation test only supported the partially mediating role of SE-OR on the relationship between family functioning and caregiver burden, while the mediating effect of self-efficacy for responding to disruptive behaviours and controlling upsetting thoughts were insignificant.

CONCLUSION

Our findings provided preliminary evidence for health professionals recommending that future studies should assess the family dynamic and health problems of caregivers, and develop appropriate family-centred interventions that focus on strengthening interfamily support and respite services to alleviate caregiver burden.

The emotional process from diagnosis to birth following a prenatal diagnosis of fetal anomaly: A qualitative study of messages in online discussion boards

OBJECTIVE

to explore written statements found in online discussion boards where parents currently expecting, or with previous experience of expecting, a child with a prenatally diagnosed congenital anomaly communicate about their emotional process from diagnosis to birth.

DESIGN

cross-sectional qualitative study of messages in public online discussion boards.

SETTING

Swedish public discussion boards about reproductive subjects.

SAMPLE

ten pregnant women and eight parents (of children with prenatal diagnoses) who had written 852 messages in five threads in Swedish online discussion boards identified via systematic searches.

MEASUREMENTS AND FINDINGS

three phases were identified in the process of moving from the diagnosis to the birth: shock, existential crisis, and life remodeling. The people posting message ('posters') moved from initial shock to existential crisis and, lastly, a phase of remodeling life later in the pregnancy. During the pregnancy, considerable worries about both antenatal and postnatal aspects were expressed. To cope with their situation, the posters distanced themselves from the diagnoses, vented their feelings, sought control, and obtained practical support from friends and relatives.

KEY CONCLUSIONS

expectant parents faced with a prenatal diagnosis move from initial shock to a phase of life remodeling and acceptance. Burdened with considerable worries, expectant parents cope with their situation through informational, emotional, and instrumental support from health professionals, family, friends, and peers.

IMPLICATIONS FOR PRACTICE

health professionals should make sure that expectant parents feel involved in planning their children's postnatal care, that they are offered sufficient information, and that they have access to emotional and instrumental support structures.

Preventive Services Use Among African American and Latino Adult Caregivers in South Los Angeles

BACKGROUND

The burden of informal caregiving is significant and well-documented, yet the evidence is mixed as to whether being a caregiver presents an additional barrier to receiving recommended preventive care.

OBJECTIVES

To determine whether (1) caregivers compared with noncaregivers were less likely to receive preventive health services; and (2) higher intensity caregivers were less likely to receive preventive health services than lower intensity caregivers.

RESEARCH DESIGN, SUBJECTS, AND MEASURES

Data were from a telephone survey of Latino and African American adults 50 years or older in South Los Angeles (n=702). Outcomes were flu vaccination, pneumococcal vaccination, and colorectal cancer screening. Logistic regression models adjusted for predisposing, enabling, and need factors according to the Andersen Model of Access to Health Care for Low-income Populations.

RESULTS

Caregiver type (eg, adult child, nonrelated) was associated with varying odds of receiving a preventive service. Caregivers had lower odds than noncaregivers of receiving preventive services although odds of receiving a flu vaccination improved slightly for caregivers of persons with memory loss compared with other caregivers. More weekly caregiving hours was associated with higher odds of receiving flu vaccination (adjusted odds ratios, 1.1; 95% confidence interval=1.0, 1.1) or colorectal cancer screening (adjusted odds ratios, 1.1; 95% confidence interval=1.0, 1.1). Caregivers and noncaregivers age 65 and older or with chronic conditions were more likely to receive vaccinations.

CONCLUSIONS

Preventive service use was influenced by characteristics of the caregiving situation. An opportunity may exist to leverage care recipients' ongoing contact with health care providers to increase caregivers' own access to preventive services.

On duty all the time: health and quality of life among immigrant parents caring for a child with complex health needs

AIMS AND OBJECTIVES

To provide knowledge about how immigrant parents of children with complex health needs manage their family lives and how this affects their own health and quality of life.

BACKGROUND

Caregivers of children with complex health needs have additional risk for general health problems and mental health problems and immigrant parents may be more vulnerable to mental distress and failing health and quality of life.

DESIGN

This qualitative study used an exploratory design with individual and focus group interviews. Data collection and analysis followed phenomenological hermeneutic guidelines.

METHODS

Individual and group interviews with 27 parents: 18 mothers and 9 fathers from Pakistan, Poland and Vietnam.

RESULTS

Immigrant parents of children with complex health needs experience their own health and quality of life challenges. They described the burden of dealing with their child's needs and special care, which affects their sleep and physical and mental health. Single mothers are particularly vulnerable.

CONCLUSION

Parents reported positive and negative effects of their caregiving experience that may affect their health and quality of life. Mothers were the primary caregivers and reported more health problems than did fathers. The lack of respite care, social networks and support impacted maternal health. Immigrant parents struggle to access resources for their child with complex health needs.

RELEVANCE TO CLINICAL PRACTICE

Hospital nurses, schools and community health care can play a valuable role in supporting the parents of children with complex health needs. It is important that parents are informed about their rights and receive a coordinator and interdisciplinary group to ensure that their needs are met with assistance and respite care. That maternal health was worse in this sample implies that health care professionals should pay more attention to reducing stress among these caregivers.

Family demands, social support and family functioning in Taiwanese families rearing children with Down syndrome

BACKGROUND

Down syndrome (DS) affects not only children but also their families. Much remains to be learned about factors that influence how families of children with DS function, especially families in non-Western populations. The purpose of this cross-sectional, correlational study was to examine how family demographics, family demands and social support relate to family functioning as well as the potential mediating effect of social support on the relationship between family demands and family functioning in Taiwanese families of children with DS.

METHOD

One hundred and fifty-five parents (80 mothers and 75 fathers) from 83 families independently completed mailed questionnaires. Data were analysed using a principal component analysis and mixed linear modelling.

RESULTS

Families having older children with DS, greater parental education, higher family income, fewer family demands and greater social support contributed to healthier family functioning. Social support partially mediated the effects of family demands on family functioning.

CONCLUSIONS

Family demographics, family demands and social support appear to be important factors that may play a critical role in how Taiwanese families respond to the birth of a child with DS. Care of children with DS and their families is likely to be more effective if professionals working with these families are aware of factors that contribute to healthy family functioning.

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.

Effects of a nursing intervention program on the depression and perception of family functioning of mothers with intellectually disabled children

AIMS AND OBJECTIVES

This study was conducted to examine the effect of psychosocial education provided to mothers with intellectually disabled children on the risk of depression and perception of family functioning in those mothers.

BACKGROUND

Families with intellectually disabled children need encouragement, support and training to more actively participate in their children's education and to positively affect their children's growth and development.

DESIGN

Randomised controlled study.

METHODS

The study included the mothers of 75 intellectually disabled children (40 intervention, 35 control). The mothers in the intervention group who participated in a routine program at private education and rehabilitation centres attended four different psychosocial educational sessions. Sessions were conducted once a week for four weeks and lasted 120 minutes. The control group attended only the routine program of the private education and rehabilitation centre.

RESULTS

Our study results showed that after completion of the educational program, there was a greater decrease in the risk for depression in the intervention group when compared to the control group, and the former perceived their family functions better. These differences were statistically significant (p < 0·001).

CONCLUSIONS

The education given by nurses to mothers who have children with intellectual disabilities may be effective in reducing the risk for depression and in increasing the perception of healthy family functioning.

RELEVANCE TO CLINICAL PRACTICE

Psychosocial nursing education program can contribute to the use of evidence-based education strategies in nursing practice to improve the mental health for mothers with intellectually disabled children.

Effects and processes linking social support to caregiver health among HIV/AIDS-affected carer-child dyads: a critical review of the empirical evidence

There is evidence to suggest that social support may be an important resource for the mental and physical health of caregivers and children affected by HIV/AIDS, especially in HIV-endemic areas of the developing world. Drawing from theory on social relations and health, in this paper we argue that it is important to assess not only the existence and direction of associations, but also the effects and processes explaining these. We refer to House et al's (in Annu Rev Sociol 14;293-318, 1988) theoretical framework on social support structures and processes as a guide to present and discuss findings of a systematic review of literature assessing the relationship between social support and health among caregivers living with HIV or caring for HIV/AIDS-affected children. Findings confirm the importance of social support for health among this population, but also expose the absence of empirical work deriving from the developing world, as well as the need for further investigation on the biopsychosocial processes explaining observed effects.

Social support as influencing primary family caregiver burden in Taiwanese patients with colorectal cancer

PURPOSE

The main purpose of this study was to describe the level of experienced burden among Taiwanese primary family caregivers (PFCs) of patients with colorectal cancer (CRC). Another purpose was to explore the relationship between demographic variables, perceived social support, and caregiver burden.

DESIGN

A cross-sectional study.

METHODS

This cross-sectional study included 100 PFCs of postsurgery colorectal cancer patients (CCPs) in one teaching hospital in the Taipei area of Taiwan. The research instruments included the Caregiver Reaction Assessment and the Medical Outcome Study-Social Support Survey.

FINDINGS

The caregivers' total burden mean was 3.00 (SD= 0.50, range = 2.00-4.19). Social support demonstrated a significant relationship with family caregiver burden (impact on health: r=-0.48, p < .01; impact on schedule: r=-0.58, p < .01; impact on finances: r=-0.44, p < .01; lack of family support: r=-0.54, p < .01; and impact on total scale: r=-0.64, p < .01). Higher perceived social support reported by caregivers predicted lower caregiver burden. Multivariate analysis identified social support as a significant independent influence on caregiver burden after controlling for key demographic variables. Social support accounted for 33% (R(2) increment = 0.33, p < .001) of the variance in caregiver burden.

CONCLUSIONS

The study highlights the importance of social support on caregiver burden in this population. Future interventions should include social support to help alleviate caregiver burden in CCPs following surgery.

CLINICAL RELEVANCE

Results of this study emphasize the important role of social support to enable healthcare professionals to become more effective while caring for caregivers of the patient with CRC who has undergone surgery. The findings of the present study may facilitate cross-cultural comparison and cultural-oriented management of caregiver burden.

Tracheostomy in infants: parent education for home care

Children with tracheostomies are increasingly discharged home for continued care by their parents. Nurses are responsible for providing these parents with the extensive education required for a smooth and successful transition to home care. This article is intended to help neonatal and pediatric nurses to effectively prepare the parents of an infant with a tracheostomy to provide safe, quality care to their child after being discharged from an acute care setting to their home. This article discusses the knowledge, attitudes, and skills the parents are required to acquire prior to the infant's discharge. Home ventilation, airway management, suctioning, tracheostomy care, emergency management, safe home environment, equipment for continuous or intermittent ventilation, and supplies necessary for care are some of the topics discussed.

Perceived social support as a moderator of the relationship between caregiver well-being indicators and psychological symptoms

The present study examined the moderating role of perceived social support in caregiver well-being indicators-psychological symptoms relationship. The data obtained from 100 caregivers of children with leukaemia revealed that the caregivers who were more able to satisfy their basic needs, and perform their daily activities, reported lower levels of psychological symptoms if they perceived higher levels of social support. However, perceived social support did not alleviate the level of psychological symptoms of the caregivers who reported lower levels of satisfaction of basic needs and performance on daily activities. The findings were discussed in the light of the literature.

Geriatric rehabilitation of stroke patients in nursing homes: a study protocol

BACKGROUND

Geriatric patients are typically underrepresented in studies on the functional outcome of rehabilitation after stroke. Moreover, most geriatric stroke patients do probably not participate in intensive rehabilitation programs as offered by rehabilitation centers. As a result, very few studies have described the successfulness of geriatric stroke rehabilitation in nursing home patients, although it appears that the majority of these patients are being discharged back to the community, rather than being transferred to residential care. Nevertheless, factors associated with the successfulness of stroke rehabilitation in nursing homes or skilled nursing facilities are largely unknown. The primary goal of this study is, therefore, to assess the factors that uniquely contribute to the successfulness of rehabilitation in geriatric stroke patients that undergo rehabilitation in nursing homes. A secondary goal is to investigate whether these factors are similar to those associated with the outcome of stroke rehabilitation in the literature.

METHODS/DESIGN

This study is part of the Geriatric Rehabilitation in AMPutation and Stroke (GRAMPS) study in the Netherlands. It is a longitudinal, observational, multicenter study in 15 nursing homes in the Southern part of the Netherlands that aims to include at least 200 patients. All participating nursing homes are selected based on the existence of a specialized rehabilitation unit and the provision of dedicated multidisciplinary care. Patient characteristics, disease characteristics, functional status, cognition, behavior, and caregiver information, are collected within two weeks after admission to the nursing home. The first follow-up is at discharge from the nursing home or one year after inclusion, and focuses on functional status and behavior. Successful rehabilitation is defined as discharge from the nursing home to an independent living situation within one year after admission. The second follow-up is three months after discharge in patients who rehabilitated successfully, and assesses functional status, behavior, and quality of life. All instruments used in this study have shown to be valid and reliable in rehabilitation research or are recommended by the Netherlands Heart Foundation guidelines for stroke rehabilitation.Data will be analyzed using SPSS 16.0. Besides descriptive analyses, both univariate and multivariate analyses will be performed with the purpose of identifying associated factors as well as their unique contribution to determining successful rehabilitation.

DISCUSSION

This study will provide more information about geriatric stroke rehabilitation in Dutch nursing homes. To our knowledge, this is the first large study that focuses on the determinants of success of geriatric stroke rehabilitation in nursing home patients.