Effects of personal characteristics, disease uncertainty and knowledge on family caregivers' preparedness of stroke survivors: a cross-sectional study

The relationship between family resilience, post-traumatic growth, and caregiver burden among family caregivers of stroke survivors: a cross-sectional study

The study aimed to explore the relationship between family resilience, post-traumatic growth(PTG), and caregiver burden among family caregivers of stroke survivors. Researchers conducted a cross-sectional study to recruit 253 family caregivers of stroke survivors from a public hospital in Shandong Province, China. Caregivers completed sociodemographic information, the Shortened Chinese Version of the Family Resilience Assessment Scale, the Post-traumatic Growth Inventory, and the Zarit Caregiver Burden Interview. We used Amos 24.0 to construct structural equation models and examine the mediating effects of stroke survivors' post-traumatic growth. Family resilience was positively associated with post-traumatic growth, and both family resilience and post-traumatic growth were negatively associated with caregiver burden. Post-traumatic growth partially mediated the relationship between family resilience and caregiver burden, and the mediating effect accounted for 21.27% of the total effect. Targeted interventions should address family resilience and post-traumatic growth as protective factors of caregiver burden.

Determinants of preparedness in family caregivers of patients with heart failure

AIMS

Inadequate preparedness of family caregivers contributes to adverse outcomes of patients with heart failure (HF). However, evidence on caregiver preparedness is limited. This study aims to examine the determinants and potential mechanisms of preparedness in family caregivers of patients with HF.

METHODS AND RESULTS

In the cross-sectional study, 298 HF patient-caregiver dyads were recruited from 4 tertiary hospitals in China. Preparedness, uncertainty in illness, family relational quality, social support, and positive aspects of caregiving (PAC) were assessed in family caregivers using self-reported questionnaires. In the path analysis model, uncertainty in illness had an indirect negative effect on preparedness via reduced PAC [indirect effect = -0.020; 95% confidence interval (CI) -0.050 to -0.002]. Whereas, family relational quality had direct (β = 0.266; P < 0.001) and indirect positive effects on preparedness through increased PAC (indirect effect = 0.027; 95% CI, 0.003-0.067). Similarly, social support also had direct (β = 0.184; P = 0.004) and indirect positive effects on preparedness through increased PAC (indirect effect = 0.027; 95% CI, 0.004-0.065).

CONCLUSION

This study highlights that diminishing uncertainty in illness may indirectly improve caregiver preparedness through the enhancement of PAC, while raising family relational quality and social support may improve caregiver preparedness both directly and indirectly by augmenting PAC. These findings provide insightful implications for healthcare professionals in developing tailored interventions to ameliorate preparedness in family caregivers of patients with HF.

The Relationship Between Preparedness for Caregiving and Spiritual Well-Being in the Carers of Stroke Patients: A Case Study in Türkiye

This study was conducted to determine the relationship between preparedness for caregiving and spiritual well-being in the carers of stroke patients. This descriptive and cross-sectional study was conducted with 130 primary carers of patients hospitalized with the diagnosis of stroke at the neurology clinic of a hospital. It was determined that the participants had moderate levels of preparedness for caregiving, they had high levels of spiritual well-being, and there was a positive significant relationship between these two variables. According to the regression analysis results, the spiritual well-being level of the participants was a predictor of their preparedness for caregiving (B: 0.144, p < 0.001). The results of this study demonstrated that the spiritual well-being of the carers of stroke patients is important in increasing preparedness for caregiving. In this context, to ensure that the carers of all stroke patients feel prepared for the caregiving process, it is recommended to evaluate their preparedness levels, support them in their preparation for their caregiving roles, and identify their spiritual needs.

Relationship Between Illness Uncertainty and Family Resilience Among Caregivers of Stroke Patients in Chinese Nuclear Families: The Mediating Role of Perceived Stress

Purpose

Stroke is a major disease endangering the health of Chinese people, and patients need to rely on the care of family members, which brings heavy caregiving burdens and pressures to caregivers and families, thus disrupting the stable family structure. In view of this, this study was to analyse the current status of family resilience among caregivers of stroke patients in Chinese nuclear families, and to explore the correlation and mechanism of action among perceived stress, illness uncertainty and family resilience.

Patients and Methods

This study used a cross-sectional research design. A total of 350 carers of stroke patients in nuclear families from four tertiary hospitals in Suzhou City, Jiangsu Province, China were selected by convenience sampling method and assessed by using demographic questionnaires, the Chinese Perceived Stress Scale (CPSS), the Parental Perceptions of Uncertainty Scale-Family (PPUS-FM), and a short Chinese version of the Family Resilience Assessment Scale (FRAS-C). Based on the above data, structural equation model was used to test the mediating role of perceived stress between illness uncertainty and family resilience.

Results

Family resilience among caregivers of stroke patients in nuclear families was at the medium lower level, illness uncertainty was at the medium level, and perceived stress was at the relatively high level. Illness uncertainty was positively correlated with perceived stress (P<0.01) and negatively correlated with family resilience (P<0.01). Illness uncertainty directly predicted family resilience (β = -0.516, p < 0.05). And the pathway between illness uncertainty and family resilience was partially mediated by perceived stress (Effect= -0.091, 95% CI [-0.141, -0.055]).

Conclusion

Healthcare professionals should pay adequate attention to the level of illness uncertainty and perceived stress among carers of stroke patients, with the need to take measures to reduce carers' illness uncertainty and perceived stress in order to improve family resilience.

The meaning of preparedness for informal caregivers of older adults: A concept analysis

AIM

To examine the concept of preparedness over time in research with informal caregivers of older adults.

DESIGN

Concept analysis.

METHODS

Rodgers' evolutionary method of concept analysis was used to guide this theoretical paper due to the dynamic nature of preparedness, which is influenced by both context and time. Using Rodgers' inductive approach, concept elements were derived from a content analysis of included studies. In the final step, to generate hypotheses and implications regarding the concept, the conceptual structure of preparedness of informal caregivers of older adults was connected to a theoretical problem in the nursing discipline using the Caregiving Stress Process Framework.

DATA SOURCES

Four databases (EBSCO CINAHL, Ovid MEDLINE, Ovid PsycINFO and Scopus) were searched in November 2022 and updated in September 2023. No date limits were set for searching, as the intent was to analyse possible variations of the concept over time.

RESULTS

The attributes of preparedness include self-confidence, having knowledge, skills and abilities to perform daily tasks, handling emotions and developed over time. These attributes can be compared with the stressors outlined in the Caregiving Stress Process Framework (i.e., the moment the caregiver identifies some 'stressor'; something that prevents them from feeling confident in their preparedness).

CONCLUSION

The concept of preparedness of informal caregivers of older adults is defined as caregiver's self-confidence about their current competence related to the knowledge, skills and abilities to perform daily tasks, and to handle emotions over time. To link the concept to a theoretical perspective, we propose adaptations to a well-known theory, the Caregiving Stress Process Framework. Future research on caregiving preparedness needs to avoid circular definitions and work with the attributes of preparedness to support caregivers.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This paper contributes to the development of interventions that focus on the health and preparedness of informal caregivers of older adults. Clarifying the concept of preparedness helps nurses to support caregivers since it is then known which aspects are included in the preparedness of caregivers (e.g., daily tasks and handling emotions). A more fulsome understanding of preparedness supports us to see beyond stressors of caregiving.

IMPACT

This study addresses informal caregivers of older adults' preparedness to provide care. We synthesized existing definitions that have been used in research with this population to propose a robust conceptualization of the concept of preparedness, which contributes to better understanding of how preparedness can be supported.

REPORTING METHOD

We were unable to locate a reporting method related to this kind of work (concept analysis).

PATIENT OR PUBLIC CONTRIBUTION

Not applicable as no new data generated.

Assessing the mediating role of family resilience between caregiver burden and caregiver capacity: a cross-sectional study among Chinese stroke survivors and family caregivers in a real-world setting

OBJECTIVES

To investigate the relationships among caregiver burden, family resilience, and caregiver capacity in the care of stroke survivors. We hypothesised that family resilience would mediate the relationship between caregiver burden and caregiver capacity.

DESIGN

A cross-sectional study design was used.

SETTING

The study was conducted in a tertiary care setting in Ningbo City, Zhejiang Province, China.

PARTICIPANTS

The study involved 413 stroke survivors and their primary caregivers.

OUTCOME MEASURES

The primary caregivers completed the Shortened Chinese Version of the Family Resilience Assessment Scale, Zarit Caregiver Burden Interview and Family Caregiver Task Inventor and provided their sociodemographic information. Stroke survivors were assessed for activities of daily living, and their sociodemographic information was provided. Data were analysed, controlling for sociodemographic variables and focusing on the mediating effect of family resilience.

RESULTS

Caregiver burden was influenced by the activities of daily living of stroke survivors, caregiver age and caregiver health status (p<0.05). Higher caregiver burden was associated with lower family resilience (p<0.01). Lower caregiver capacity corresponded to heavier caregiver burden (p<0.01). Family resilience mediated the relationship between caregiver burden and caregiver capacity (b=0.1568; 95% CI: 0.1063 to 0.2385).

CONCLUSIONS

Enhancing family resilience can reduce caregiver burden and improve caregiver capacity in stroke care. These findings underscore the importance of developing interventions focused on nursing skills and family resilience.

Caregiver Burden and Readiness in Patients with Moderate and Severe Traumatic Brain Injury: The Chain Mediation Effect of Disease Uncertainty and Mental Resilience

OBJECTIVE

To analyze the mediating effects of caregiver illness uncertainty and psychological resilience in caregiver burden and readiness in patients with moderate-to-severe traumatic brain injuries (TBIs). This can help improve caregiver readiness in patients with moderate-to-severe TBIs.

METHODS

A purposive sampling method was used to recruit patients with moderate-to-severe TBIs, and their caregivers, who were hospitalized in the Department of Neurosurgery of the Affiliated Hospital of Yangzhou University between October 2022 and August 2023. The Zarit Caregiver Burden Interview, Mishel Uncertainty In Scale for Family Member, Connor-Davidson Resilience Scale, and Caregivers Preparedness Scale, as well as general information questionnaire, were used to conduct the survey.

RESULTS

Caregiver readiness correlated with caregiver burden, illness uncertainty, and psychological resilience in patients with moderate-to-severe TBI (P < 0.01). Caregiver readiness was not only directly affected by caregiver burden (95% confidence interval: -0.510, -0.196) but was also affected through the chain mediation of illness uncertainty and psychological resilience (95% confidence interval: -0.146, -0.011).

CONCLUSIONS

Caregiver burden in patients with moderate-to-severe TBI influences caregiver readiness levels and is mediated by illness uncertainty and psychological resilience. By improving caregivers' illness uncertainty and increasing their psychological resilience, the impact of low caregiver readiness caused by high caregiver burden could be reduced.

Associations between preparedness, perceived stress, depression, and quality of life in family caregivers of patients with a temporary enterostomy

PURPOSE

To investigate the preparedness, perceived stress, risk of depression, and quality of life of family caregivers of patients receiving a temporary enterostomy, to provide a reference for improving the long-term care and quality of life of patients receiving a temporary enterostomy.

METHODS

We enrolled 181 family caregivers of patients in a hospital in China from 2021 to 2023. Responses to the General Information Questionnaire, the Chinese Caregiver Preparedness Scale, the Chinese Perceived Stress Scale, the Chinese bilingual version of the Patient Health Questionnaire-2, and the 12-item Short Form Survey were collected online.

RESULTS

Pearson's correlation analysis revealed that family caregivers' risk of depression was negatively correlated with their preparedness, the physical component summary score, and the mental component summary score but was positively correlated with perceived stress. Multiple linear regression analysis identified factors influencing caregiver preparedness.

CONCLUSIONS

These findings help healthcare personnel to identify high-risk individuals among family caregivers of patients receiving a temporary enterostomy. This provides a basis for formulating well-planned, dynamic health education programs that meet patients' needs for disease-related knowledge and care.

Perceived Stress and Level of Uncertainty Among Hospitalized COVID-19 Patients

Introduction

Disease uncertainty refers to the inability to assign meaning to events related to the illness. Uncertainty of the disease can affect various aspects of human life such as psychological aspects.

Objectives

This study aims to examine the relationship between disease uncertainty and perceived stress in COVID-19 patients.

Methods

An analytical cross-sectional study was conducted on 212 hospitalized COVID-19 patients who were initially admitted to the intensive care units (ICUs) and later transferred to general wards within the same hospitals. Three instruments were utilized to collect data for this study. The Demographic Information Questionnaire, Mishel Uncertainty in Illness Scale (MUIS) for disease uncertainty, and Perceived Stress Questionnaire. For data analysis, both descriptive and inferential statistics were employed using IBM SPSS Statistics version 25.

Results

The Pearson correlation coefficient matrix results showed a positive and significant relationship between uncertainty about the illness (P < .001, r = 0.829), ambiguity (P < .001, r = 0.795), complexity (P < .001, r = 0.835), inconsistency or instability (P < .001, r = 0.787), and unpredictability (P < .001, r = 0.776) with perceived stress in COVID-19 patients transferred from the intensive care units.

Conclusion

Based on the findings of the current study, both uncertainty and perceived stress are elevated among COVID-19 patients, and a significant and direct relationship exists between these two variables. Healthcare providers, particularly nurses, should address the uncertainties surrounding emerging diseases, both at the hospital and community levels.

The Uncertainty in Family Caregivers of Hospitalized Persons With a Stroke in Saudi Arabia: Unitary Caring Perspective

Uncertainty is a universal experience of family caregivers caring for persons with a stroke and affects caregivers' readiness to care for their family members with a stroke. Guided by the unitary caring theory and unitary-caring hermeneutic-phenomenological research method, this study was conducted among 15 family caregivers of persons in the hospital who have survived strokes through in-depth semi-structured interviews. Five essences emerged from the analysis: living in a dark reality; yearning for professional support; enduring a life full of tribulations; attempting resolution; and creating new patterns of living. Each of the 5 essences was interpreted from Smith's unitary caring theory perspective.

The impact of informal caregivers' preparedness on short-term outcomes of heart failure patients with insufficient self-care

AIMS

Even though self-care is essential in the long-term management of heart failure (HF), it is often not performed adequately in HF populations. Mobilizing informal caregivers may be one way to help patients perform self-care, support individual needs, and maintain health. However, informal caregivers often face insufficient preparation for providing long-term care. This insufficient caregiver preparedness may lead to a decline in caregiver contributions and affect the outcomes of care in patients with HF. This study aimed to explore whether informal caregivers' preparedness is a predictor that influences short-term outcomes of HF patients; to analyse whether caregiver contribution to self-care of HF (CC-SCHF) plays a mediating role between informal caregivers' preparedness and HF short-term outcomes.

METHODS AND RESULTS

A prospective observational study was conducted in China. After controlling for covariates, higher levels of informal caregivers' preparedness were significantly associated with lower 3-month mortality [odds ratio (OR) = 0.919, 95% confidence interval (CI) = (0.855-0.988), P = 0.022] and 3-month readmission rate [OR = 0.883, 95% CI = (0.811-0.961), P = 0.004] and shorter length of hospital stay (β = -0.071, P < 0.001). The informal caregiver's preparedness was positively associated with CC-SCHF maintenance (r = 0.708, P < 0.01), CC-SCHF management (r = 0.431, P < 0.01), and CC-SCHF confidence (r = 0.671, P < 0.01). The CC-SCHF management was a mediator in the relationship between informal caregivers' preparedness and 3-month readmission rate [effect 95% CI = (-0.054 to -0.001)] and length of hospital stay [effect 95% CI = (-0.235 to -0.042)].

CONCLUSION

A higher level of informal caregivers' preparedness is associated with better short-term outcomes of HF patients with insufficient self-care.

Knowledge, attitude, and practice regarding stroke potential complications among stroke survivors' family members in Shiraz, Iran

Objectives

This study aimed to evaluate stroke survivors' family members' knowledge, attitude, and practice about these sequelae.

Patients and methods

In this cross-sectional survey, 105 family members (57 males, 48 females; mean age: 48.3±9.7 years; range 18 to 60 years) of stroke survivors were examined via a self-structured questionnaire between September 2019 and January 2020. Patients' medical characteristics, as well as participants' sociodemographic and opinions regarding studying variables, were surveyed.

Results

The participants were mostly married and had relatively high scores in knowledge, attitude, and practice questionnaires. We found a significant correlation between participants' knowledge and practice. Moreover, data analysis revealed significantly higher knowledge scores in the employed participants and higher practice scores in the urban population. Furthermore, the relationship of patients with their family members can affect their attitude toward stroke complications.

Conclusion

This study has revealed that caregivers in rural areas with lower education levels are less knowledgeable about potential stroke complications, and subsequently, the patients are more vulnerable to those sequelae. Stakeholders should consider these groups their priorities in education and empowerment processes for stroke survivors' caregivers.

The Influence of Informal Caregivers' Preparedness on Psychological Symptoms and Quality of Life Among Patients With Heart Failure And Insufficient Self-care

BACKGROUND

Most patients with heart failure find self-care difficult to perform and rely on family caregivers for support. Informal caregivers, however, often face insufficient psychological preparation and challenges in providing long-term care. Insufficient caregiver preparedness not only results in psychological burden for the informal caregivers but may also lead to a decline in caregiver contributions to patient self-care that affects patient outcomes.

OBJECTIVE

Our objective was to test (1) the association of baseline informal caregivers' preparedness with psychological symptoms (anxiety and depression) and quality of life 3 months after baseline among patients with insufficient self-care and (2) the mediating effects of caregivers' contributions to self-care of heart failure (CC-SCHF) on the relationship of caregivers' preparedness with patients' outcomes at 3 months.

METHODS

A longitudinal design was used to collect data between September 2020 and January 2022 in China. Data analyses were conducted using descriptive statistics, correlations, and linear mixed models. We used model 4 of the PROCESS program in SPSS with bootstrap testing to evaluate the mediating effect of CC-SCHF of informal caregivers' preparedness at baseline with psychological symptoms or quality of life among patients with HF 3 months later.

RESULTS

Caregiver preparedness was positively associated with CC-SCHF maintenance (r = 0.685, P < .01), CC-SCHF management (r = 0.403, P < .01), and CC-SCHF confidence (r = 0.600, P < .01). Good caregiver preparedness directly predicted lower psychological symptoms (anxiety and depression) and higher quality of life for patients with insufficient self-care. The associations of caregiver preparedness with short-term quality of life and depression of patients with HF with insufficient self-care were mediated by CC-SCHF management.

CONCLUSIONS

Enhancing the preparedness of informal caregivers may improve psychological symptoms and quality of life of heart failure patients with insufficient self-care.

The effect of COVID-19 patient care and emergency response interprofessional training on COVID-19 knowledge, perception, behavior and readiness for care

BACKGROUND

During the COVID-19 pandemic, the need for Interprofessional Education (IPE) and collaborative practices have gained even more importance.

OBJECTIVE

The aim of this study is to evaluate the impact of IPE on COVID-19 on students' knowledge, perceptions, behaviors and readiness for care regarding COVID-19.

METHOD

The study followed a single-group pre-/post-test semi-experimental research design. The sample consisted of 435 students studying Elderly Care/Home Patient Care/First and Emergency Aid programs. The students' perception of interdisciplinary education was evaluated at the beginning of the study.

RESULTS

The students were given an online COVID-19 Patient Care and Emergency Response IPE that lasted five hours and was split into two parts. The perception of interdisciplinary education was significantly higher among female students and first and emergency students before receiving IPE. Before and after IPE, the knowledge level scores of the students who did not receive IPE were found to be higher than those who did. After the training, the students' knowledge levels, readiness for care and their perceptions of control towards the COVID-19 pandemic increased statistically significantly (p < 0.001).

CONCLUSION

The students' knowledge levels and perceptions of control surrounding the pandemic may grow as a result of the IPE given about COVID-19 during the pandemic, when IPE became more important, and students may feel more prepared to care.

Competencia del cuidar y sobrecarga del cuidador de la persona con enfermedad crónica hospitalizada

Objetivo: Describir la competencia del cuidar y su asociación con la sobrecarga del cuidador familiar de la persona con enfermedad crónica. Método: Estudio cuantitativo descriptivo, transversal, muestreo por conveniencia. Se aplicó la ficha de caracterización de la díada, Instrumento CUIDAR y Zarit. 102 cuidadores de personas con enfermedades crónicas en las áreas hospitalarias, que cumplían los criterios de inclusión. Resultados: Predominan las mujeres como cuidadores, nivel de escolaridad bajo, sobrecarga en un 56,8%, alto nivel de competencia para cuidar 68,6%. Relación estadísticamente significativa con la variable sobrecarga y la calificación global de la competencia CUIDAR así como con sus dimensiones: Conocimiento, Unicidad, Anticipación. Conclusión: La competencia de cuidar se asocia con la sobrecarga del cuidador de personas con enfermedad crónica no transmisible. Por lo tanto, Enfermería tiene la responsabilidad de identificar las necesidades del cuidador e intervenirlas para contribuir en la transición hacia el rol de cuidador en el egreso del paciente al hogar. 

Status and influencing factors of disease uncertainty among family caregivers of patients with moderate and severe craniocerebral injury: a quantitative and qualitative study

BACKGROUND

Disease uncertainty widely exists among family caregivers of patients with moderate and severe craniocerebral injury. This negative emotional reaction will reduce the ability of family caregivers to make decisions during the critical stage of the patient, causing serious effects on the rescue and prognosis of patients with moderate and severe craniocerebral injury. Therefore, this article aims to understand the state of the uncertainty of the disease of family caregivers of patients with moderate and severe craniocerebral injury in China, to analyze the influencing factors, and to explore the specific resource of the uncertainty of the disease combined with qualitative study. The outcomes will provide a theoretical basis for formulating an accurate clinical nursing intervention strategy.

METHODS

This study was conducted in the neurosurgery ward. A total of 214 family caregivers were evaluated using five previously validated scales: (i) Mishel Uncertainty in Illness Scale for family member, (ii) Simplified Coping Style Questionnaire, (iii) Social Support Rating Scale, and (iv) Self-Rating Anxiety Scale, (v) Zarit Caregiver Burden Interview. Kolmogorov-Smirnov was used to test the normality of the data distribution. The potential determinants of disease uncertainty were evaluated using the univariate statistical analysis. A multivariate linear regression model was adopted to assess the predictors of disease uncertainty in family caregivers of patients with moderate and severe craniocerebral injury. Objective sampling method was used to conduct semi-structured interviews with 17 family caregivers of patients with moderate and severe craniocerebral injury, and Colaizzi 7-step analysis method was used to analyze and summarize the interview data.

RESULTS

The evaluated participants exhibited critically high levels of perceived uncertainty. The results of multiple linear regression showed that the influencing factors of family caregivers' disease uncertainty were anxiety, number of other caregivers, GOS, negative coping style, and caregiver burden. The qualitative research focuses on two main topics: the sources of disease uncertainty among family caregivers of patients with moderate and severe craniocerebral injury and experience to cope with the situation.

CONCLUSION

The main cause of disease uncertainty of family caregivers of patients with moderate and severe craniocerebral injury is that patients' disease progression and prognosis as well as caregivers' own pressure of responsibility and negative mental status. Furthermore, caregivers' own pressure of responsibility and negative mental status are not clear. Therefore, helping family caregivers adopt positive coping approaches, guiding them to actively seek support from family and society, improving their nursing skills, and understanding of disease progression and prognosis all play an important role in alleviating the uncertainty of the disease.

Uncertainty among families of patients with cerebrovascular diseases in Japan: association with quality of life and background characteristics

Purpose

To determine the relationship between family uncertainty and family quality of life (QOL) during the recovery period of patients with cerebrovascular disease in Japan, and the factors that influence family uncertainty.

Methods

Data were collected from copies of patient medical files and interviews with family members of 85 patients admitted to two rehabilitation wards in Japan. Family uncertainty was measured using the Japanese version of the Managing Uncertainty in Illness Scale–Family Member form (MUIS-FM) and family QOL using the World Health Organization Five Well-Being Index (WHO-5). Multiple linear regression analysis was applied to investigate associated factors.

Results

WHO-5 score was significantly negatively associated with MUIS-FM score (β =  − 0.236, p = 0.03); other factors associated with MUIS-FM score were the Care Shared Decision-Making Questionnaire for care providers score (β =  − 0.384, p < 0.001), Short Intolerance of Uncertainty Scale score (β = 0.296, p = 0.001), and history of surgical treatment (β = 0.199, p = 0.032).

Conclusions

Family QOL could be improved by reducing family uncertainty. It is also suggested that promoting shared decision-making between healthcare providers and patients’ families may help reduce family uncertainty. It is necessary to take into account not only family intolerance of uncertainty but also uncertainty that varies by type of acute care provided.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-022-02254-1.

Perceived factors contributing to the care provided by informal (family) and formal caregivers of older adults with noncommunicable diseases in rural communities: A qualitative focus group study

BACKGROUND

Informal and formal caregivers of older adults with noncommunicable diseases (NCDs) are important in every aspect of current caregiving for older adults by understanding reality specific to direct experiences perceived by each person in caring for older adults in order to develop nursing knowledge and using knowledge to plan care for older adults with NCDs to have a good quality of life. The current study aimed to investigate the points of view on factors concerning the care provided by informal and formal caregivers providing care for older adults with chronic diseases in the community.

MATERIALS AND METHODS

This study was conducted with a qualitative design. The sample was 5 informal and 20 formal caregivers providing care for patients with chronic diseases, namely hypertension and diabetes mellitus. Furthermore, a qualitative approach was used with four focus groups (FGs) with 25 informants. Data were collected during March-August 2021 in rural communities of Nakhon Phanom Province, Thailand. Finally, the qualitative analysis used content analysis; FG data were analyzed using content analysis in which a preliminary set of codes was determined according to other documented experiences of patients.

RESULTS

The findings revealed three main themes emerging in the data obtained on the perceived factors contributing to the care provided by informal and formal caregivers: "caregivers' knowledge," "factors related to caregivers" and "community factors."

CONCLUSION

Points of view on the factors correlated with the care provided by informal and formal caregivers of older adults with chronic diseases that explain and confirm the findings can be used to plan care with effects on quality of life among older adults with chronic diseases.

Predictive model for the preparedness level of the family caregiver

Background

Many caregivers are insufficiently prepared, and little is known about measures that can be employed to enhance their preparedness.

Aim

The aim of this study was to explore the factors associated with caregiver preparedness and establish a predictive model including the relationship between preparedness, burden, resilience and anxiety.

Design

A cross‐sectional design was used.

Methods

The sample included 172 family caregivers who were selected from one private hospital and daytime nursing centres. Caregivers were recruited from 2018 to 2019; they completed assessments for caregiver preparedness, anxiety, resilience and burden. A multiple linear regression analysis was performed to identify the factors associated with preparedness.

Results

Preparedness was significantly associated with high levels of resilience and a low level of burden, while it was not associated with anxiety. Caregivers' gender, experience and cohabitation status were the main predictors. Resilience is an explanatory factor for caregiver preparedness in the predictive model.

Conclusion

The demographic variables related to preparedness can be used to guide efforts to meet the needs of vulnerable caregivers. A caregiver's preparedness depends on their level of burden and resilience. Nursing interventions focused on these aspects could make the caregiver's role easier and improve the quality of care provided.

What is already known about this topic?

Many caregivers are inadequately prepared for this role, and ensuring adequate preparedness is important for family caregivers.

Preparedness and factors predictive of this in Spanish family caregivers have not been well‐documented.

Resilience, burden and anxiety affect caregivers, but the degree to which they influence caregivers' preparation levels is unknown.

What is the contribution of this paper?

Specific factors influence the preparedness of family caregivers. Men and caregivers who do not cohabit in the same household with the care‐dependent person may present greater deficits in preparedness. Moreover, poor health and lack of experience in caring can result in inadequate caregiving performance.

Readiness, resilience and burden are significantly related, and the best predictor of family caregivers' preparedness is resilience.

Resilience leads to greater preparedness in caregivers, and better‐prepared caregivers experience a lighter burden.

What are the implications of this paper?

Knowing the factors associated with preparedness in advance will allow health‐care professionals to prevent deficits in vulnerable family caregivers.

Resilience is a decisive factor which prevents negative consequences such as low preparedness. A resilient coping style can diminish the burden and promote successful adaptation in caregivers.

Factors associated with the well-being of family caregivers of people with dementia

BACKGROUND

Improving the health and well-being of family caregivers of people with dementia has become an increasingly important public health and policy issue in China. The aims of this study were to clarify the factors associated with the well-being of family caregivers of people with dementia in China.

METHODS

Data were collected from a sample of 132 family caregivers who volunteered to study and live together with people with dementia who had been treated as outpatients in three hospitals in China. The survey included questions on the family caregivers' characteristics, satisfaction with family support, positive aspects of caregiving, preparedness of caregiving, and characteristics of people with dementia. Multiple linear regression analysis was carried out to identify factors associated with the well-being of family caregivers.

RESULTS

The mean age of the family caregivers (68.2% women) was 46.8 ± 14.9 years. The results of multiple linear regression analysis indicated that positive aspects of caregiving (β = 0.352, P < 0.001), satisfaction with family support (β = 0.219, P < 0.01), activities of daily living of people with dementia (β = 0.265, P < 0.05), and household size (β = -0.184, P < 0.05) were related to the well-being of family caregivers.

CONCLUSIONS

The findings from this study indicated that positive aspects of caregiving, satisfaction with family support, activities of daily living of people with dementia, and household size were significant factors related to the well-being of family caregivers. These findings could be expected to aid healthcare providers in identifying the optimal solution to enhance the well-being of family caregivers in China.

Resilience and caregiving ability among caregivers of people with stroke: The mediating role of uncertainty in illness

BACKGROUND

In China, stroke survivors are usually cared for by their family members. However, the caregiving ability of these informal caregivers remain inadequate during the hospitalization of their family members following a sudden onset of a stroke, and this sudden need for care overwhelms caregivers even after the hospital discharge. Therefore, research is required to identify predictors of caregiving ability that could be targeted in future interventions aimed at improving caregiving skills and reducing the burden on caregivers who care for stroke survivors.

MATERIALS AND METHODS

From August 2019 to February 2020, stroke survivors were hospitalized for the first time, and their family caregivers were registered via convenience sampling. Caregiver demographic information, resilience status, uncertainty in illness, caregiving ability, and patients' severity of stroke were measured using standardized questionnaires. Structural equation modeling was used to test the proposed model, where caregiver resilience and stroke severity predicted caregiving ability directly, and uncertainty in illness mediated the association between caregiver resilience and caregiving ability.

RESULTS

A total of 306 dyads were included in the study. The tested model fit the data well (χ² = 118.2, df = 64, RMSEA = 0.053, CFI = 0.946, TLI = 0.923). Statistically significant pathways linked caregivers' resilience status to uncertainty in illness (β = -0.558, S.E. = 0.022, P < 0.01), caregivers' resilience to the status of caregiving ability (β = -0.269, S.E. = 0.013, P < 0.01) and caregivers' uncertainty about the illness to caregiving ability (β = 0.687, S.E. = 0.051, P < 0.01). We also found that caregivers' uncertainty in illness mediated the association between caregivers' resilience and caregiving ability (β = -0.384, S.E. = 0.061, P < 0.01).

CONCLUSIONS

Our structural equation modeling result identified resilience and uncertainty about the illness as predictors of the caregiving ability of informal family caregivers who suffered from care burdens. Supporting family caregivers to build their resilience and reduce illness uncertainty may improve caregiving for stroke survivors.

Evaluation of care burden and caregiving preparedness in caregivers of patients with epilepsy: A sample in eastern Turkey

AIM

This study was conducted to evaluate the care burden and caregiving preparedness in caregivers of patients with epilepsy.

METHODS

This descriptive, cross-sectional study evaluated the caregivers of patients with epilepsy who were referred to the neurology outpatient clinic of a university hospital in Erzurum, eastern Turkey, between February 2020 and February 2021. The study was carried out with 147 volunteers among the patients with epilepsy who were referred to the neurology outpatient clinic between the specified dates. The data were collected with Caregiver Question Form, the Brief Disability Questionnaire (BDQ), the Burden Interview (BI), and the Preparedness for Caregiving Scale (PCS).

RESULTS

The mean BI score of the caregivers who participated in the study was 43.14 ± 18.08, their mean PCS score was 14.12 ± 7.76, and their mean BDQ score was 10.53 ± 4.65. In the regression analysis conducted, it was found that being married, having little knowledge of patient care, undertaking all of the roles in caregiving and having caregiving duration of 24 months and longer had a negative effect on PCS total score, while having an undergraduate degree and higher had a positive significant effect. It was found that having an undergraduate degree and higher had a negative effect on BI total score, while all of the roles undertaken in caregiving had a positive significant effect on BI total score. It was found that PCS had a negative significant effect on BI total score (p < 0.001).

CONCLUSION

Caregivers of patients with epilepsy had a moderate level of burden and caregiving preparedness, and the patients cared for had a moderate level of disability. Caregiver burden increased as disability of patients with epilepsy and the tasks undertaken in caregiving increased, whereas burden decreased as caregiver education and caregiving preparedness increased.