The intimate mediator: a carer's experience of Alzheimer's

A Meta-Synthesis on Sexuality in Persons with Dementia Mapped Using the Model of Human Occupation

Dementia affects the individual's functional ability including sexual activity. Limited understanding is available to support sexual health practices. This meta-synthesis review aimed to identify the gaps in the study of sexuality in dementia using the Model of Human Occupation (MOHO). Electronic searches utilizing six databases for existing articles involving persons living with dementia, care partners, and healthcare workers. The result showed that available studies primarily explored sexuality from the viewpoint of spouses of persons living with dementia. The volition domain of MOHO was the most explored provides a deeper understanding of volition on intrinsic perspective on sexuality in people with dementia. The environment domain was the least explored, highlighting healthcare professionals' need for social support and training. The topic of sexuality remains sensitive, limiting the availability of evidence-based interventions in this area.

Interventions for adult family carers of people who have had a stroke: a systematic review

Objective: A systematic review of the effectiveness of interventions for adult family carers of people with stroke, and an exploratory examination of the relationship between the conceptual basis of these interventions and their effectiveness.

Data sources: Seventeen electronic databases and grey literature sources were searched, including ASSIA, BNI, Cochrane Library, CINAHL, EMBASE, MEDLINE, PsycINFO, Social Science Citation Index and the Science Citation Index, HMIC and the National Research Register. Authors of unpublished material were contacted for data and additional publications. Reference and citation tracking was performed on included publications.

Review methods: Inclusion criteria: randomized controlled trials of interventions aimed primarily at adult family carers of people post stroke; carers were the primary sample; primary outcomes reported were for carers. Two independent reviewers screened titles and abstracts to identify publications and extract data. Quality assessment was performed to weight study findings.

Results: Eight papers were found reporting on six complex, generally heterogeneous, interventions: caregiver training; education and counselling; social problem-solving partnerships, delivered principally by telephone; a psycho-educational telephone support group; a nurse-led support and education programme; and a support programme, delivered either to groups in hospital or individuals during home visits. Half of the interventions were based on stress-coping theories; the remainder did not identify a conceptual basis for the intervention.

Conclusions: Some benefits were reported for all interventions, although trials were generally of low quality, preventing firm conclusions being drawn. The presence of a conceptual basis for interventions does not appear to influence effectiveness.

Caring Leadership: A Heideggerian Perspective

This paper develops the idea of caring leadership based on Heidegger’s philosophy of care. From this perspective, caring leadership is grounded in the practices of ‘leaping-in’ and ‘leaping-ahead’ as modes of intervention in the affairs of the world and the efforts of others. This involves gauging and taking responsibility for the ramifications of intervention, balancing the urge for certainty of outcome and visibility of contribution with the desire to encourage and enable others. Our analysis suggests several twists to contemporary leadership debates. We argue that the popular models of transactional and transformational leadership are to be critiqued not for their over-reliance but, rather, their under-reliance on agency. This is a different kind of agency to that of heroic or charismatic models. It involves tolerance of complexity and ambivalence; a rich sense of temporal trajectory; concern for one’s presence in the world; and crucially, the ability to resist the soothing normativity of ‘best practice’. From this position, we argue that the problem with the growing scholarly interest in an ethic of care is that it provides too tempting a recipe to follow. In a Heideggerian view, caring leadership has little to do with compassion, kindness or niceness; it involves and requires a fundamental organization and leadership of self.

Liminality as a conceptual frame for understanding the family caregiving rite of passage: an integrative review

Family caregiving is a significant rite of passage experienced by family caregivers of individuals with protracted illness or injury. In an integrative review of 26 studies, we characterized family caregiving from the sociocultural perspective of liminality and explored associated psychosocial implications. Analysis of published evidence on this dynamic and formative transition produced a range of themes. While role ambiguity resolved for most, for others, uncertainty and suffering continued. The process of becoming a caregiver was transformative and can be viewed as a rebirth that is largely socially and culturally driven. The transition to family caregiving model produced by this review provides a holistic perspective on this phenomenon and draws attention to aspects of the experience previously underappreciated. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Self-administered intervention for caregivers of persons with Alzheimer's disease

The purpose of this article is to describe the development and feasibility testing of a Transition Toolkit to support caregivers of persons with Alzheimer's disease (AD) in dealing with transitions. Using the Medical Research Council (MRC; UK) guidelines for complex intervention development, Step 1 was to develop a theoretical understanding of the likely processes of change, by reviewing existing evidence and theory, and conducting new primary research. Based on Step 1, the intervention was developed with the Alzheimer's Society experts (Step 2), followed by concept mapping of the critical inputs of the intervention with the theoretical understanding (Step 3). A feasibility study was then conducted with 20 caregivers of persons with AD (Step 4) using a mixed methods concurrent design. The preliminary findings of the pilot study were positive with the participants describing the Transition Toolkit as acceptable, easy to use, and having the potential to help deal with transitions.

Impact of dementia on marriage: A qualitative systematic review

This qualitative review explored the impact of dementia on marriage. The method was informed by systematic review and qualitative research methodologies. A comprehensive search of major databases was undertaken. The search identified 115 studies on the topic; 23 met the inclusion criteria and 19 were appraised as being of good methodological quality. Two major themes and five sub-themes emerged from the analysis of included studies, transition and loss. The theme of transition encompassed the three sub-themes of relationship, roles and intimacy and reflected the changes in the marriage and marital relationship that accompanied dementia. The theme of loss encompassed the two sub-themes of loss of a partner and loss of a marriage, which reflected the many losses that accompanied dementia. However, transition and loss were inter-related, because each change was accompanied by loss and each loss produced another change in the marriage.

Using meta-ethnography to understand the emotional impact of caring for people with increasing cognitive impairment

The majority of people with degenerative neurological conditions are cared for within their own families. Cognitive impairment can be a significant and increasing symptom of these conditions. In this article we report how a team of experienced researchers carried out a meta-ethnography of qualitative research articles focusing on the impact of caring for a loved one with cognitive impairment. We followed the seven-step process outlined by Noblit and Hare. Synthesized findings from 31 papers suggest emotional impact is complex and uncertain and varies from day to day. The benefit of using meta-ethnography is that the results represent a larger sample size and a reinterpretation of multiple studies can hold greater application for practice. The results of this study offer an opportunity for nurses to be aware of both the positive and negative sides of caring and being cared for. This knowledge can be used to discuss with patients and carers how best to prepare for decreasing cognition and still maintain a worthwhile quality of life.

Psychosocial factors that shape patient and carer experiences of dementia diagnosis and treatment: a systematic review of qualitative studies

BACKGROUND

Early diagnosis and intervention for people with dementia is increasingly considered a priority, but practitioners are concerned with the effects of earlier diagnosis and interventions on patients and caregivers. This systematic review evaluates the qualitative evidence about how people accommodate and adapt to the diagnosis of dementia and its immediate consequences, to guide practice.

METHODS AND FINDINGS

We systematically reviewed qualitative studies exploring experiences of community-dwelling individuals with dementia, and their carers, around diagnosis and the transition to becoming a person with dementia. We searched PubMed, PsychINFO, Embase, CINAHL, and the British Nursing Index (all searched in May 2010 with no date restrictions; PubMed search updated in February 2012), checked reference lists, and undertook citation searches in PubMed and Google Scholar (ongoing to September 2011). We used thematic synthesis to identify key themes, commonalities, barriers to earlier diagnosis, and support identified as helpful. We identified 126 papers reporting 102 studies including a total of 3,095 participants. Three overarching themes emerged from our analysis: (1) pathways through diagnosis, including its impact on identity, roles, and relationships; (2) resolving conflicts to accommodate a diagnosis, including the acceptability of support, focusing on the present or the future, and the use or avoidance of knowledge; and (3) strategies and support to minimise the impact of dementia. Consistent barriers to diagnosis include stigma, normalisation of symptoms, and lack of knowledge. Studies report a lack of specialist support particularly post-diagnosis.

CONCLUSIONS

There is an extensive body of qualitative literature on the experiences of community-dwelling individuals with dementia on receiving and adapting to a diagnosis of dementia. We present a thematic analysis that could be useful to professionals working with people with dementia. We suggest that research emphasis should shift towards the development and evaluation of interventions, particularly those providing support after diagnosis.

The carer’s world: An interactive reusable learning object

Visual and interactive environments offer unique opportunities for emotive and immersive experiences related to health. Examples concerning Alzheimer’s include the film Ex memoria, documentaries like Malcolm and Barbara: Love’s farewell and the Remember us virtual exhibit within Second life. In 2006, the School of Health and Social Care (HSC) began experimenting with integrating the methods and themes of Lifeworld with Hypertext narrative into an educational resource. This process led to the development of a reusable learning object — The carer’s world — designed to give users greater knowledge about, and insight into, the challenges of caring for people with Alzheimer’s. This article describes the context, processes and influences of its creation and a discussion of how this type of development might increase knowledge and understanding around the issues of a carer’s world and also provide a tool for embedding into the higher educational health curriculum.

Elements of psychocardiology in the psychosocial handling of adults with congenital heart disease

When it comes to the role of the clinical psychology in the cardiac settings, or psychocardiology, there is often a focus on acquired cardiac illnesses in the rehabilitation settings. However, the increase of adults with congenital heart disease due to technological advances in cardiology and cardiac surgery have created a new emergency. It is thus necessary to reflect upon the elements of psychocardiology adapting them to this new population, also when it comes to interventional hospital settings of cardiology and cardiac surgery. This perspective article is an effort in this direction.

Renewing everyday hope: the hope experience of family caregivers of persons with dementia

The purpose of this grounded theory study was to explore the experience of hope for family members caring for a person with dementia. Seventeen family members caring for persons with dementia were interviewed. The participants described their hope as the possibility of a positive future within their daily lives and in the social context of grief and loss, stress, fatigue, and constantly dealing with challenging behaviours of the person with dementia. The main concern of the study participants was "fading hope," which they dealt with by "renewing every day hope" through (a) coming to terms, (b) finding positives, and (c) seeing possibilities.

Narratives in a users' and carers' group: meanings and impact

BACKGROUND

Carers who wished to share their experiences with a national working group (the Consumer Group) prepared narratives as a way of identifying areas for discussion.

METHODS

The narratives were submitted to one author and subjected to thematic qualitative analysis. The themes were fed back to the Group for discussion.

RESULTS

Five main themes were identified: difficulties in obtaining a diagnosis; acting as an advocate; stresses of caring; practical problems with social care; and emotions experienced by carers.

CONCLUSIONS

The narratives provided a means of sharing carers' experiences and creating initiatives for further action by the Group. They have an impact on the people who hear or read them but may also be therapeutic for those who produce them. Narratives can also be a powerful tool in teaching and training, and in identifying areas for service and professional improvement.

Lifeworld-led healthcare: revisiting a humanising philosophy that integrates emerging trends

In this paper, we describe the value and philosophy of lifeworld-led care. Our purpose is to give a philosophically coherent foundation for lifeworld-led care and its core value as a humanising force that moderates technological progress. We begin by indicating the timeliness of these concerns within the current context of citizen-oriented, participative approaches to healthcare. We believe that this context is in need of a deepening philosophy if it is not to succumb to the discourses of mere consumerism. We thus revisit the potential of Husserl's notion of the lifeworld and how lifeworld-led care could provide important ideas and values that are central to the humanisation of healthcare practice. This framework provides a synthesis of the main arguments of the paper and is finally expressed in a model of lifeworld-led care that includes its core value, core perspectives, relevant indicative methodologies and main benefits. The model is offered as a potentially broad-based approach for integrating many existing practices and trends. In the spirit of Husserl's interest in both commonality and variation, we highlight the central, less contestable foundations of lifeworld-led care, without constraining the possible varieties of confluent practices.

Informal care as relationship: the case of the Magnificent Seven

Continual and/or repetitive informal caring and the part childhood, developmental and socially constructed identity play roles in adult informal care, form the background to the questions of why individuals gravitate toward such relationships and why they often continue to care in the face of overwhelming obstacles. A synthesis of the literature is presented, leading to personal histories as a method of discovery. The Biographic Narrative Interpretive Method's minimalist interview technique is put forth as the key data-gathering event. Reflecting teams, underpinned by hermeneutics or interpretive phenomenology, are used for the analyses. Data from in-depth, biographic interviews with two informal carers (a mother and her adult son) from a seven-member, three-generational family are presented. The study reveals that this family defines disability as a status that they share in common: disability demonstrates relationships and keeps the family together, but discourages mobility. It is suggested that often-unmet childhood needs propelled these particular individuals into demonstrating those needs as adults by assuming informal care relationships. The case is made that their biographies impact upon their management of health and enduring illnesses within caring roles. Further biographic research within the caring profession is recommended.