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Nóbrega VMD, Viera CS, Lorenzini E, Neves ET, Reichert APDS, Vaz EMC, Collet N. Hospital discharge intervention developed in a dialogical way with families to prepare them to care for children with chronic diseases at home: Mixed methods study. J Child Health Care 2024; 28:637-657. [PMID: 36853118 DOI: 10.1177/13674935231159827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
A convergent parallel mixed methods design with qualitative data collection embedded in a quasi-experimental study was developed to examine the potential of three modalities of preparation for hospital discharge of the families of children with chronic diseases in terms of uncertainty levels and management of the disease at home. Caregivers of these children were divided into three groups: two experimental groups and one control group. Two scales were applied: one measured family management, and the other evaluated uncertainties in relation to the disease. In addition, an in-depth interview was conducted. Wilcoxon's test and the integrated response index were used in data analysis to compare performance between the groups. Inductive thematic analysis was employed for the qualitative data. The data were integrated, comparing the groups before and after preparation for hospital discharge. Twenty-five family caregivers completed this study. Data integration showed that the intervention group, in which the families developed planning to prepare for discharge in a dialogical way with professionals, presented better perceptions regarding care management when compared to structured guide and usual care groups. Participation of families in planning for hospital discharge showed a reduction in uncertainties regarding the disease and better care management of children at home.
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Affiliation(s)
| | - Claudia Silveira Viera
- Nursing Collegiate and the Graduate Program in Bioscience and Health at Western State University of Parana - Unioeste, Cascavel, Brazil
| | - Elisiane Lorenzini
- Department of Nursing and the Graduate Program in Nursing, Universidade Federal de Santa Catarina - Campus Florianópolis, Florianopolis, Brazil
| | - Eliane Tatsch Neves
- Department of Nursing and the Graduate Program in Nursing, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | | | - Elenice Maria Cecchetti Vaz
- Department of Public Health and the Graduate Program in Nursing, Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Neusa Collet
- Department of Public Health and the Graduate Program in Nursing, Universidade Federal da Paraíba, João Pessoa, Brazil
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Videon TM, Rosati RJ, Finn S. The Importance of Providing Training to Informal Caregivers of Hospice Patients: Caregiver Experience With Hospice Care Based on Consumer Assessment of Healthcare Providers & Systems Surveys. Am J Hosp Palliat Care 2024:10499091241262804. [PMID: 38901845 DOI: 10.1177/10499091241262804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Informal caregivers aid hospice patients at the end of life. Little is known of their preparation and confidence in providing care, and how this relates to experiences of hospice care. OBJECTIVE Examine factors associated with informal caregivers' rating of home hospice care. METHODS Data come from 828 completed CAHPS® surveys mailed between January 2022 and December 2023 from a single non-profit Hospice organization. Multivariate logistic regression analyses examined the independent influence of various aspects of hospice care on ratings of hospice. RESULTS Nine of every 10 respondents rated hospice care high (9 or 10). Most aspects of hospice care were rated favorably. Nearly all respondents felt the patient was treated with dignity and respect (96%). The measure with the greatest room for improvement was getting help as soon as needed (82% "always"). Multivariate analyses revealed 6 factors that independently predicted overall rating of hospice care. The strongest predictor was always getting help as soon as needed, followed by believing the hospice team cared about the patient. Three measures of caregiver training were significantly associated with higher ratings of hospice care being trained to: safely move the patient, what to do if patient became restless, and on pain medications. CONCLUSIONS When informal caregivers feel trained to assess and manage the symptoms, they rate hospice care more favorably. Greater attention to informal caregiver training and support are imperative to improving hospice care.
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Affiliation(s)
- Tami M Videon
- Connected Health Institute, The Visiting Nurse Association Health Group, Inc, Neptune, NJ, USA
| | - Robert J Rosati
- Connected Health Institute, The Visiting Nurse Association Health Group, Inc, Neptune, NJ, USA
| | - Stephanie Finn
- Connected Health Institute, The Visiting Nurse Association Health Group, Inc, Neptune, NJ, USA
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Borges LADC, Almeida RGDS, Barboza ES, Arruda GOD. Simulation training of caregivers at hospital discharge of patients with chronic diseases: an integrative review. Rev Bras Enferm 2023; 76:e20230043. [PMID: 38055488 DOI: 10.1590/0034-7167-2023-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/11/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE to identify evidence about the use and effects of clinical simulation for preparing caregivers for discharging patients with chronic conditions. METHODS an integrative peer review in the Scopus, PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect and Virtual Health Library databases, from July to September 2022. RESULTS 3,218 studies were identified, with a final sample consisting of four national and two international articles. Using simulation as an educational technology contributed to caregiver preparation in home care. In most studies, using clinical simulation included using other strategies to complement training: expository dialogued class, conversation circle and audiovisual resources. FINAL CONSIDERATIONS simulation proved to be efficient for training caregivers, with the active participation of family members and nurses in health education actions.
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Affiliation(s)
| | | | - Elton Santo Barboza
- Universidade Federal de Mato Grosso do Sul. Campo Grande, Mato Grosso do Sul, Brazil
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Oakley S, Dunbar H, de Vries K. Parent-led strategies supporting personal well-being when caring for a child with a life-limiting condition: A scoping review. J Child Health Care 2022; 26:648-667. [PMID: 34372722 DOI: 10.1177/13674935211026122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The objectives of this review were to identify strategies initiated by parents of children with life-limiting conditions to support their own well-being at home and to describe the impact of these strategies on parental well-being. A systematic scoping review was performed using PRISMA-ScR guidelines, identifying 15 relevant studies that fit the inclusion and exclusion criteria. There were no studies that specifically assessed how parents support their own well-being; however, the 15 identified studies did provide pertinent data secondary to the primary aims of each study. This resulted in the identification of 14 parent-initiated strategies which were grouped thematically into 4 categories: (i) social experience and peer support, (ii) information and management techniques, (iii) reframed perspectives and (iv) prioritising own needs. Overall, there was some evidence of parents initiating specific, individualised and useful strategies to supporting their well-being. Notably lacking was any empirical evaluation as to the effectiveness of these strategies and the wider factors associated with them. Further research is required to assess how parents support their personal well-being in daily life and how these strategies can be implemented alongside service-initiated support to ensure full parental well-being.
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Affiliation(s)
- Sarah Oakley
- Leicester School of Nursing and Midwifery, 4487De Montfort University, Leicester, UK
| | - Helena Dunbar
- Leicester School of Nursing and Midwifery, 4487De Montfort University, Leicester, UK
| | - Kay de Vries
- Leicester School of Nursing and Midwifery, 4487De Montfort University, Leicester, UK
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Silva MD, Charlo PB, Zulin A, Santos FGTD, Jaques AE, Haddad MDCFL, Radovanovic CAT. Construction and validation of clinical scenarios for training informal caregivers of dependent persons. Rev Bras Enferm 2022; 75:e20220140. [PMID: 36259877 DOI: 10.1590/0034-7167-2022-0140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/04/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE To construct and validate three clinical scenarios for training dependent persons' informal caregivers. METHODS Methodological study, conducted between January and August 2021, in a municipality in the northwest of the state of Paraná. It was developed in two stages: construction of scenarios; and content validation by experts (n = 12). To estimate the degree of agreement between the experts, the content validity index was used, and 80% was considered an acceptable rate of agreement. RESULTS The simulation scenarios proved appropriate, obtaining an average value of 91.6%. However, some adjustments were made in their organization pertaining clarity in the wording of guidelines, as suggested by the expert validators. CONCLUSIONS The construction and validation of the clinical scenarios proved to be adequate and relevant for use in the training of informal caregivers of dependent persons.
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Affiliation(s)
| | | | - Aline Zulin
- Universidade Estadual de Maringá. Maringá, Paraná, Brazil
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Khankeh HR, Ebadi A, Norouzi Tabrizi K, Moradian ST. Home health care for mechanical ventilation-dependent patients: A grounded theory study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2157-e2168. [PMID: 34791719 DOI: 10.1111/hsc.13654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 10/16/2021] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Abstract
The number of people requiring home mechanical ventilation is increasing. Both family and patients experience a quite different situation. There is a significant knowledge gap about the caring process, families and health care team responsibilities, challenges they face, and how they manage. This study aimed to discover the process of home health care (HHC) to mechanical ventilation-dependent patients. The Straus and Corbin version of the grounded theory method was used. The preliminary study was conducted in 2015, and then for updating the theory, a complementary study was done in 2019. Sampling began purposefully and then was followed by theoretical sampling. A total of 28 participants, including 14 professional health care workers, 12 family members, and two improved patients were interviewed. Data were analysed using MAXQDA 2010 with constant comparative analysis method. After this step and the formation of concepts, structure, and the relation between them and exploring the process, the related theory was presented. The data analysis revealed 64 primary categories, that have been clustered into eight categories, and finally in three main concepts of "challenging care with stress and ambivalence", "step-by-step care delegation", and "professional and limited". After organising the memos, drawing the diagrams, and writing the storyline, "challenging care with stress and ambivalence" emerged as the main concern. Families tend to provide care without reducing quality. So, using the "step-by-step care delegation" strategy they delegate the care from professional to unprofessional caregivers. This strategy could lead to the "supported independence" of families and "professional development" of nurses. Families experience a challenging situation during care delivery to mechanical ventilation-dependent patients at home. The most important challenge is insufficient insurance coverage and an inappropriate legal framework for service delivery. Hence, the study results could be used by policymakers to improve HHC policies.
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Affiliation(s)
- Hamid Raza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Kian Norouzi Tabrizi
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyed Tayeb Moradian
- Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Silva MD, Charlo PB, Zulin A, Santos FGTD, Jaques AE, Haddad MDCFL, Radovanovic CAT. Construção e validação de cenários clínicos para capacitação de cuidadores informais de pessoas dependentes. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2022-0140pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RESUMO Objetivo: Construir e validar três cenários clínicos para capacitação de cuidadores informais de pessoas dependentes. Métodos: Estudo metodológico, realizado entre janeiro e agosto de 2021, em um município no noroeste do estado do Paraná. Foi desenvolvido em duas etapas: construção dos cenários; e validação do conteúdo por experts (n = 12). Para estimar o grau de concordância entre os juízes, utilizou-se o índice de validade de conteúdo, e considerou-se o valor de 80% como uma taxa aceitável de concordância. Resultados: Os cenários de simulação mostraram-se apropriados, obtendo valor médio de 91,6%. No entanto, foram feitos alguns ajustes em sua organização no que tange à clareza na redação das orientações, conforme sugestão dos juízes. Conclusões: A construção e validação dos cenários clínicos mostraram-se adequadas e relevantes, de modo que eles podem ser utilizados na capacitação de cuidadores informais de pessoas dependentes.
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Moonpanane K, Kodyee S, Potjanamart C, Purkey E. Adjusting the family's life: A grounded theory of caring for children with special healthcare needs in rural areas, Thailand. PLoS One 2021; 16:e0258664. [PMID: 34695121 PMCID: PMC8544842 DOI: 10.1371/journal.pone.0258664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/03/2021] [Indexed: 11/19/2022] Open
Abstract
This study aims to understand the experiences of families of children with special healthcare needs in rural areas in Thailand. Grounded theory (GT) was employed to understand families' experiences when caring for children with special healthcare needs (CSHCN) in rural areas. Forty-three family members from thirty-four families with CSHCN participated in in-depth interviews. Interviews were recorded and transcribed. The constant comparative method was used for data analysis and coding analysis. Adjusting family's life was the emergent theory which included experiencing negative effects, managing in home environment, integrating care into a community health system, and maintaining family normalization. This study describes the process that families undergo in trying to care for CSHCN while managing their lives to maintain a sense of normalcy. This theory provides some intervention opportunities for health care professionals when dealing with the complexities in their homes, communities and other ambulatory settings throughout the disease trajectory, and also indicates the importance of taking into consideration the family's cultural background.
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Affiliation(s)
| | - Salisa Kodyee
- School of Nursing, Mae Fah Luang University, Chiang Rai, Thailand
| | | | - Eva Purkey
- Department of Family Medicine, Faculty of Health Science, Queen’s University, Kingston, Canada
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"This Is How Hard It Is". Family Experience of Hospital-to-Home Transition with a Tracheostomy. Ann Am Thorac Soc 2021; 17:860-868. [PMID: 32267725 DOI: 10.1513/annalsats.201910-780oc] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Expansion of chronic ventilation options and shared decision-making have contributed to an increasing population of technology-dependent children. One particularly vulnerable group is children with tracheostomy who depend on technology for basic respiratory functions. Chronic critical care is now provided in the homecare setting with implications for family caregivers.Objectives: This study explores the experience of family caregivers of children and young adults with a tracheostomy during the transition from hospital to home care. We sought to identify the specific unmet needs of families to direct future interventions.Methods: We recruited a convenience sample of families from an established home ventilation program to participate in semistructured interviews. Sessions were conducted in person or via teleconference. A grounded-theory qualitative analysis was performed.Results: Between March 2017 and October 2018, we interviewed 13 individuals representing 12 families of children and/or young adults with tracheostomy. Patients ranged in age from 9 months to 28 years, had a tracheostomy for 8 months to 18 years, and represented a variety of underlying diagnoses. Five key themes emerged: 1) navigating home nursing; 2) care coordination and durable medical equipment (DME) impediments; 3) learning as a process; 4) managing emergencies; and 5) setting expectations.Conclusions: Our findings support the need for family-centered discharge processes including coordination of care and teaching focused on emergency preparedness.
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Capilla-Díaz C, Moya-Muñoz N, Matas-Terrón JM, Pérez-Morente MÁ, Álvarez-Serrano MA, Montoya-Juárez R, Hueso-Montoro C. Evaluation of interventions in people with digestive stoma through the Nursing Interventions Classification. Int J Nurs Knowl 2021; 33:40-48. [PMID: 34003579 DOI: 10.1111/2047-3095.12328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine which nursing interventions are used in individuals with a digestive stoma and the relationships between nursing interventions used and sociodemographic and clinical variables. METHODS The present study is an observational, cross-sectional, descriptive. Data from 102 individuals in the general surgery unit of a first-level hospital (University Hospital Complex of Granada, Spain) were analyzed. Data on the use of nursing interventions and sociodemographic and clinical variables were collected. Univariate, bivariate, and multivariate data analyses were conducted. FINDINGS Interventions: Decision-Making Support (5250) and Ostomy Care (0480) were the most prevalent interventions in the sample. The period of care (postoperative and follow-up) was the most common significant variable (p < 0.05) among the interventions observed. Anxiety Reduction (5820), Nutritional Counseling (5246), Self-Esteem Enhancement (5400), and Body Image Enhancement (5220) were also relevant findings. CONCLUSIONS The present study contributes to determining which nursing interventions are used in individuals with a digestive stoma. IMPLICATIONS FOR NURSING PRACTICE This study could be useful in planning nursing interventions in individuals with a digestive stoma.
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Affiliation(s)
| | | | | | | | | | - Rafael Montoya-Juárez
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - César Hueso-Montoro
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
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Given CW. Family Caregiving for Cancer Patients: the State of the Literature and a Direction for Research to Link the Informal and Formal Care Systems to Improve Quality and Outcomes. Semin Oncol Nurs 2019; 35:389-394. [PMID: 31229345 DOI: 10.1016/j.soncn.2019.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Based on recent shifts in reimbursement for cancer treatment from fee-for-service to bundled and value-based payment, this concluding article summarizes data from these papers and the large body of literature on caregiving to suggest how caregiving research might be redirected to link the formal with the informal systems to achieve higher-quality and lower-cost care. Caregiver dyads, the tasks of care, and strategies for training are presented. DATA SOURCES Articles in this issue of Seminars in Oncology Nursing, the larger body of caregiving literature, and the Oncology Care Model driving bundled payments and value-based care. CONCLUSION Research on informal caregiving for cancer patients should begin to reframe the rich body of evidence available toward a focus on caregivers reactions to the tasks of care, the training necessary for caregivers to perform them, and how each contributes to quality care at lower costs and appropriate outcomes given patients' stage of disease and goals of treatment. IMPLICATIONS FOR NURSING PRACTICE Oncology systems must take a more active role in including patients and their families as partners to manage treatments and side effects to achieve the best possible patient outcomes. They must be able to evaluate the patient and the caregiver to determine what tasks they will be able to perform, and then make sure they have the training and resources to carry out those tasks. Training could be done by social media and through communication using patient portals that could be expanded through the electronic medical records to include caregiver portals, enabling caregiver questions and reports of patients' conditions.
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Affiliation(s)
- Charles W Given
- College of Nursing, Michigan State University, East Lansing, MI.
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Green SM, Townsend K, Jarrett N, Fader M. The experiences and support needs of people living at home with an enteral tube: a qualitative interview study. J Hum Nutr Diet 2019; 32:646-658. [DOI: 10.1111/jhn.12656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- S. M. Green
- School of Health Sciences University of Southampton Highfield, Southampton UK
- Solent NHS Trust Hampshire UK
| | - K. Townsend
- School of Health Sciences University of Southampton Highfield, Southampton UK
| | - N. Jarrett
- School of Health Sciences and Social Work University of Portsmouth Portsmouth UK
| | - M. Fader
- School of Health Sciences University of Southampton Highfield, Southampton UK
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