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Xu S, Lou VWQ, Chi I, Ng WC, Zhou J, Huang LK, Hok Ka Ma C, Jagasia M. Validating interRAI Chinese self-reported carer needs (SCaN) assessment and predicting caregiving distress among informal Chinese caregivers of older adults. BMC Geriatr 2024; 24:409. [PMID: 38720258 PMCID: PMC11080141 DOI: 10.1186/s12877-024-05014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND This study aims to (1) determine the reliability and validity of the interRAI Chinese Self-reported Carer Needs (SCaN) assessment among informal Chinese caregivers of older adults, (2) identify predictors of caregiving distress in Asian regions with long-standing Confucian values of filial piety and family responsibility. METHODS This cross-sectional study recruited 531 informal Chinese caregivers of older adults in Hong Kong, Shanghai, Taiwan, and Singapore. The scale reliability was examined using Cronbach's alphas (α) and McDonald's omega coefficient (ω). The concurrent validity and discriminant validity were assessed using Spearman rank correlations (rho). To examine the predictors of caregiving distress among informal caregivers of older adults, we employed hierarchical linear regression analyses informed by the Model of Carer Stress and Burden and categorized the predictors into six domains. RESULTS Results revealed good internal consistency reliability (α = 0.83-0.96) and concurrent validity (rho = 0.45-0.74) of the interRAI Chinese SCaN assessment. Hierarchical linear regression analysis revealed that entering the background factors, primary stressors, secondary stressors, appraisal, and exacerbating factors all significantly enhanced the model's predictability, indicating that the source of caregiving distress is multidimensional. In the full model, caregivers with longer informal care time, lack of support from family and friends, have unmet needs, experience role overload, have sleep problems, and low IADL functioning are at a higher risk of caregiving distress. CONCLUSIONS The interRAI Chinese SCaN Assessment was found to be a reliable and valid tool among the Chinese informal caregivers of older adults. It would be useful for determining family caregivers' strengths, needs, and challenges, and tailoring interventions that address the potentially modifiable factors associated with caregiving distress and maximize support. Healthcare providers working in home and community settings should be aware of the early identification of caregiving distress and routine assessment of their needs and empower them to continue taking care of their needs and providing adequate care to the care recipient.
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Affiliation(s)
- Shicheng Xu
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
- Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong, China
| | - Vivian W Q Lou
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China.
- Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong, China.
| | - Iris Chi
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA
| | | | - Jing Zhou
- Department of Social Sciences, Faculty of Social Sciences and Business Studies, University of Eastern Finland, Joensuu, Finland
- Department of Social Sciences, Faculty of Social Sciences and Business Studies, Shanghai Lixin University of Accounting and Finance, Shanghai, China
| | - Lung-Kuan Huang
- St. Camillus Long-term Care Center, Yi-lan County, Taiwan
- Fo Guang University, Yi-lan County, Taiwan
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Zabeen S, Phua D, Mohammadi L, Lawn S. Family involvement to support cardiovascular self-management care for people with severe mental illness: a systematic review. J Ment Health 2023; 32:290-306. [PMID: 32924668 DOI: 10.1080/09638237.2020.1818194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Family members play a pivotal role in supporting cardiovascular self-management-based care of community-living adults with severe mental illness (SMI). However, little is known about what strategies caregivers employ as part of their caring roles. AIM This paper aims to explore what caregiving strategies work (or not), why and how by collating and synthesising existing evidence on this issue. METHODS A systematic search of peer-reviewed qualitative and mixed-method studies published between 2000 and 2019 was employed. This comprehensive process generated only nine papers for subsequent meta-synthesis of qualitative data. RESULTS Findings suggested that caregivers have a complex yet comprehensive role to play in initiating and perpetuating self-management-based cardiovascular care. The elements of recovery such as promoting hope, normality, autonomy and identity were flagged as critical underpinning factors that motivated the person with SMI to adopt a healthy lifestyle. However, it was evident that caregivers needed to walk alongside the person, at times, to help them reach their maximum potential in sustaining improved self-management behaviours. CONCLUSION Caregivers sit in a favourable bridging position between healthcare systems and community-living individuals with SMI, to support their cardiovascular health. However, this powerful but invisible 'workforce' clearly needs further support involving finance, skill-development and acknowledgement.
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Affiliation(s)
- Sara Zabeen
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Delphine Phua
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Leila Mohammadi
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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Pickering J, Crooks VA, Snyder J, Milner T. Relational, community-based and practical: Support systems used by Canadian spousal caregivers living seasonally in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2311-2319. [PMID: 35285564 DOI: 10.1111/hsc.13781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/09/2022] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
Every year tens of thousands of older Canadians travel to the southern United States (US) to live there seasonally during the winter months to enjoy a warmer climate-a practice known as international retirement migration. Several factors facilitate participation in this transnational mobility, including having the financial resources needed to live abroad. For those managing chronic or acute health conditions, traveling with a caregiver (typically a spouse) is another important facilitator. In this qualitative analysis, we explore the transnational systems of support that Canadian international retirement migrant spousal caregivers draw upon to enable them to provide care while in the US. We report on the findings of ten semi-structured dyad interviews (n = 20 participants) conducted with Canadian international retirement migrants living seasonally in Yuma, Arizona. The dyads consisted of spouses, one of whom had defined care needs and the other of whom provided informal care. Through thematic analysis of these interviews, we identified three types of transnational support systems that spousal caregivers draw on: relational, community-based and practical. While aspects of these support systems have been documented in other informal care-giving studies, this analysis demonstrates their copresence in the transnational care-giving context associated with international retirement migration. Overall, this analysis highlights the benefits of close social relations enjoyed by international retirement migrants providing informal care to mitigate the lack of access to their established support networks at home.
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Affiliation(s)
- John Pickering
- Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Jeremy Snyder
- Simon Fraser University, Burnaby, British Columbia, Canada
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Laidsaar-Powell R, Keast R, Butow P, Mahony J, Hagerty F, Townsend J, Young J, Butt Z, Juraskova I. Improving breast cancer nurses' management of challenging situations involving family carers: Pilot evaluation of a brief targeted online education module (TRIO-Conflict). PATIENT EDUCATION AND COUNSELING 2021; 104:3023-3031. [PMID: 33941422 DOI: 10.1016/j.pec.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Given the stressful and emotional nature of cancer, challenging interactions between nurses, patients, and family frequently occur. Nurses are rarely equipped with strategies to avoid or de-escalate stressful situations with carers, which can include displays of conflict, anger, or dominance. A brief online education module (TRIO-Conflict) was developed to provide nurses with management strategies to use in situations of conflict. This study aimed to assess the feasibility, acceptability, and potential efficacy of TRIO-Conflict. METHODS Nurses were recruited through an Australian breast cancer organisation (McGrath Foundation). Participants completed pre/post module measures of attitudes towards carers, confidence in their skills to effectively navigate challenging interactions with carers, and applied knowledge of management strategies. Data were analysed using Wilcoxon signed-rank tests. Qualitative feedback was analysed using content analysis. RESULTS 52 nurses completed pre-/post- measures, with 4 semi-structured interviews conducted. Significant improvements in attitudes towards carers (p = .010) and confidence in one's own ability to manage challenging interactions with carers (p < .001) were found, but not knowledge of strategies. Most nurses found TRIO-Conflict very/extremely helpful (87%) and were satisfied with content (94%) and usability (93%). CONCLUSION TRIO-Conflict utilised evidence-based learning techniques (provision of example phrases, video vignettes, reflective exercises) to improve nurses attitudes and confidence. PRACTICE IMPLICATIONS TRIO-Conflict is a brief, targeted, clinically relevant, and easily accessible online training programme which could be widely disseminated to oncology nurses.
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Affiliation(s)
- Rebekah Laidsaar-Powell
- The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Sydney, New South Wales, Australia.
| | - Rachael Keast
- The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Sydney, New South Wales, Australia
| | - Phyllis Butow
- The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Sydney, New South Wales, Australia
| | | | | | | | - Jade Young
- McGrath Foundation, Sydney, NSW, Australia
| | - Zoe Butt
- The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Sydney, New South Wales, Australia
| | - Ilona Juraskova
- The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Sydney, New South Wales, Australia
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Parmar J, Anderson S, Duggleby W, Holroyd-Leduc J, Pollard C, Brémault-Phillips S. Developing person-centred care competencies for the healthcare workforce to support family caregivers: Caregiver centred care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1327-1338. [PMID: 32949440 DOI: 10.1111/hsc.13173] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/30/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
Family caregivers (FCGs) are an integral part of the healthcare system. Currently, FCGs provide 70%-90% of the care required by community-dwelling children and adults living with complex chronic conditions and frailty. Despite FCG's contributions and the growing proportion of distressed caregivers, support for FCGs has not been a health system priority. Researchers have proposed training to enhance the competencies of health providers to work effectively with FCGs. In the absence of best practices for the competency indicators for caregiver-centred care, we have developed a competency framework for training the health workforce to support FCGs. The objectives in this paper are fourfold: (a) a brief review of stakeholder engagement that led to the development of the competencies the health workforce needs to support FCGs, (b) a description of the process used to name the competency domains, (c) a report on the Modified Delphi process (conducted 2019) used to validate the domain indicators, and (d) a description of the competency framework. We adopted a caregiver and a multilevel interdisciplinary stakeholder codesign approach throughout the competency development process. The competency domains include: (a) Recognising the Caregiver Role, (b) Communicating with FCGs, (c) Partnering with FCGs, (d) Fostering Resilience in FCGs, (e) Navigating Health and Social Systems and Accessing Resources, and, (f) Enhancing the Culture and Context of Healthcare. Our Caregiver-Centred Care Competencies for the health workforce are only a first step in supporting FCGs in their vital roles. There are few education and training resources to enable and empower health providers to support FCGs, there is an urgent need to develop training resources for the health workforce to recognise and support FCGs.
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Affiliation(s)
- Jasneet Parmar
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Edmonton Zone Home Living, Alberta Health Services, Edmonton, AB, Canada
| | - Sharon Anderson
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, Brenda Strafford Foundation Chair in Geriatric Medicine, University of Calgary, Calgary, AB, Canada
| | - Cheryl Pollard
- Bachelor of Science in Nursing, McEwan University, Edmonton, AB, Canada
| | - Suzette Brémault-Phillips
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, USA
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Campione JR, Zebrak KA. Predictors of Unmet Need Among Informal Caregivers. J Gerontol B Psychol Sci Soc Sci 2021; 75:2181-2192. [PMID: 31907540 DOI: 10.1093/geronb/gbz165] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study investigates the relationship of caregiver demographics, caregiving intensity, caregiver support use, and aspects of the caregiving situation to a self-reported measure of unmet need among U.S. informal caregivers of older adults living at home with various conditions. METHODS Response data from 1,558 caregiver participants interviewed by telephone during the December 2016 baseline period of the Outcome Evaluation of the National Family Caregiver Support Program were used. Caregivers who responded "Definitely No" to the question "Are you receiving all the help you need?" were classified as reporting unmet need. Logistic regression was used to find significant factors associated with unmet need among the full sample and among caregivers tiered by three levels of burden. RESULTS Unmet need was reported by 22% of the caregivers. In a fully adjusted model, unmet need was predicted by higher levels of caregiving intensity, non-White race of the caregiver, and the caregiver not feeling appreciated by their care recipient. Other predictors associated with unmet need were no use of caregiver educational services, fewer respite hours, not living in a rural area, and caregiver having an education past high school. DISCUSSION Caregivers who do not feel appreciated by their care recipient and non-White caregivers should be identified as potential targets for intervention to address unmet need, especially if they are also reporting higher levels of caregiver burden. Understanding the factors associated with self-reported unmet need can assist caregiver support programs in measuring and addressing the needs of informal caregivers to support their continued caregiving.
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Affiliation(s)
- Joanne R Campione
- Department of Healthcare Delivery Research and Evaluation, Westat, Inc., Rockville, Maryland
| | - Katarzyna A Zebrak
- Department of Healthcare Delivery Research and Evaluation, Westat, Inc., Rockville, Maryland
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Chen CF, Huang FL, Chen YC, Wang IF, Huang YP. Maternal Caregiving for Children Newly Diagnosed with Acute Lymphoblastic Leukemia: Traditional Chinese Mothering as the Double-Edged Sword. J Pediatr Nurs 2020; 53:e64-e71. [PMID: 32199680 DOI: 10.1016/j.pedn.2020.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 12/25/2022]
Abstract
AIMS AND OBJECTIVES To explore the meaning of maternal caregiving in the Chinese culture for children newly diagnosed with acute lymphocytic leukemia (ALL). BACKGROUND Recurrence of and death associated with ALL remain the main concerns for mothers. Mothers experience guilt and anxiety towards their child's cancer. DESIGN Descriptive phenomenological study. METHODS Twelve mothers were recruited from a medical centre in Central Taiwan. The mothers were primary caregivers for their child diagnosed as having ALL in the past 3 months to 1 year. Data were collected through semi-structured interviews and analysed using Colaizzi's method. RESULTS Four main themes emerged: feeling this world crashing by knowing the diagnosis, feeling the double-edged sword of mothering, worrying about potential risks for their vulnerable child, and passing through difficulties with power of support. CONCLUSIONS Most mothers felt this world crashing due to potential loss of their child and seeing their child's suffering. The mother was blamed for her child's cancer but was also required to shoulder all caregiving for their child. The mothers needed to compromise their lives to protect their child from potential infection. Perceived power of support helped the mothers overcome difficulties. RELEVANCE TO CLINICAL PRACTICE Findings support that nurses encouraging mothers to tell their stories, regardless of culture, will facilitate healing. Establishing trust and providing support from nurses, physicians, psychologists and social workers will lead mothers' readiness to deal with care of their sick child. Increasing visiting time for parental support for children hospitalized in the PICU is suggested as well.
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Affiliation(s)
- Chun-Fei Chen
- Department of Nursing, HungKuang University, Taiwan.
| | - Fang-Liang Huang
- Division of Oncology, Department of Pediatrics, Taichung Veterans General Hospital, Taiwan; Department of Physical Therapy, HungKuang University, Taiwan.
| | | | - I-Fan Wang
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan.
| | - Yu-Ping Huang
- School of Nursing, National Quemoy University, Taiwan.
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Konradsen H, Brødsgaard A, Østergaard B, Svavarsdóttir E, Dieperink KB, Imhof L, Luttik ML, Mahrer-Imhof R, García-Vivar C. Health practices in Europe towards families of older patients with cancer: a scoping review. Scand J Caring Sci 2020; 35:375-389. [PMID: 32291782 DOI: 10.1111/scs.12855] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION In Europe, cancer is one of the predominant causes of mortality and morbidity among older people aged over 65. A diagnosis of cancer can imply a negative impact on the quality of life of the older patients and their families. Despite research examining the impact of cancer on the family, it is unclear what kind of information is available about the types of clinical practice towards older patients with cancer and their families. The aim is to determine the extent, range and variety of research in Europe describing health practices towards families of older patients with cancer and to identify any existing gaps in knowledge. METHODS Scoping review. RESULTS A total of 12 articles were included, showing that family interventions are generally based on end-of-life care. Most studies used a qualitative approach and involved different types of family member as participants. Most studies were conducted in the UK. CONCLUSIONS Review findings revealed limited knowledge about health practices in Europe towards families with an older patient with cancer. This review indicates a need to increase family-focused research that examines health practices that meet the needs of families of older patients with cancer. Seeing cancer as a chronic disease, there is an urgent need for the implementation of family-focused interventions.
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Affiliation(s)
- Hanne Konradsen
- Department of Gastroenterology, Herlev and Gentofte Hospital, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Institutet, Solna, Sweden
| | - Anne Brødsgaard
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark.,Section for Nursing, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Birte Østergaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Erla Svavarsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Karin B Dieperink
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Oncology and Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Lorenz Imhof
- Community-Based Care, Nursing Science & Care Ltd, Winterthur, Switzerland
| | - Marie Louise Luttik
- Family Care, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Romy Mahrer-Imhof
- Community-Based Care, Nursing Science & Care Ltd, Winterthur, Switzerland
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