Outcome indicators for direct and indirect caregiving

A trial of dementia caregiver telephone support

The purpose of this study was to determine if telephone support groups for dementia caregivers have an effect on bother with patient behaviours, burden, depression, and general well-being. The randomized controlled trial compared telephone support groups (15 groups of 5 or 6 caregivers) with control groups (print materials). Groups met 14 times over 1 year. The 1-hour sessions included content on education, coping skills, and support. Data were collected at baseline and at 6 and 12 months. The sample comprised 154 caregivers, 77 per arm, providing care to veterans with dementia or a veteran caregiver. Bother was found to differ significantly at baseline. There were no significant treatment effect differences between study arms. Participants anecdotally reported improvement. It was concluded that telephone support groups are an efficient way to interact with caregivers. Further research should test different models of care. Interventions that are targeted to specific needs or occur frequently may provide better support for caregivers of individuals with a worsening condition.

Evaluating Palliative Care—A Review of the Literature

The purpose of this article was to investigate the outcome measures developed and used in palliative care. The paper involved a literature review of published research. Many of the reviewed papers concluded similarly that there was lack of good quality evidence on which to base conclusions. More high quality evidence is needed to compare the relative merits of the differences in models of palliative care services, so that we can learn from other appropriate systems of care at end of life. It follows that quality of life is the main outcome of palliative care, in which the patient instead of the disease represents the target of the clinical approach. Patients struggling with serious illness have other concerns, including managing pain and other symptoms, coordinating care among multiple providers and settings, ensuring that treatments reflect preferences and balance benefits and harms as well as clinical appropriateness, achieving empathic communication and care, fostering well-being, maintaining function and practically supporting family and caregivers through illness and bereavement.

Whatever It Takes: Informal Caregiving Dynamics in Blood and Marrow Transplantation

PURPOSE/OBJECTIVES

To describe the dynamics of commitment, expectations, and negotiation from the perspective of caregivers of patients undergoing blood and marrow transplantation (BMT).

RESEARCH APPROACH

Descriptive, exploratory, qualitative methodology.

SETTING

Comprehensive cancer center in a major southern U.S. city.

PARTICIPANTS

40 caregivers of patients undergoing BMT.

METHODOLOGIC APPROACH

Story theory guided audiotaped dialogues with caregivers.

MAIN RESEARCH VARIABLES

Commitment, expectations, and negotiation.

FINDINGS

Commitment is an enduring responsibility that encourages supportive presence, inspires life changes to make the patient a priority, and leads to a self-affirming, loving connection. Expectations are clarified as expectation management, which is envisioning the future and yearning to return to normal, taking one day at a time, gauging behavior from past experiences, and reconciling treatment twists and turns. Role negotiation is appropriate pushing by a caregiver toward patient independence after getting a handle on complex care and attending to patient voice (patient preferences and wishes).

CONCLUSIONS

Commitment, expectation management, and role negotiation sustain informal caregivers in their role.

INTERPRETATION

Acknowledging caregivers' contributions, giving focused information as needed, and providing a safe environment in which to build coherent caregiving stories can assist caregivers. Research is needed to confirm the effectiveness of interventions with caregivers and to understand patients' role in the dynamics of informal caregiving.

The experience of family members caring for a dying loved one

Qualitative nursing research into the experience of family members caring for a dying loved one has been limited. This study used a phenomenological approach to explore this experience. The pattern of caring for a dying loved one and its intertwined dimensions were described. Caregivers felt a sense of helplessness that was associated with illness progression, their inability to relieve pain and discomfort, and decision-making related to patient admission to a palliative care unit. Lack of support from health professionals and having to face personal limits were found to accelerate the decision to admit a patient. The role of a support person involved with the caregiver was also considered and found to be an area worthy of further investigation. Health professionals must provide information and support tailored to the caregivers' needs as they change along a patient's illness trajectory.

Family carers of ICU survivors: a survey of the burden they experience

Intensive care unit (ICU) survivors may experience deterioration in their quality of life for months following their return home, with families assuming a caregiving role. The aim of this study was to measure the burden associated with caring for a family member who had been critically ill. The study also sought to describe the relationship between three factors (filial obligation, social support, self-efficacy) and caregiver burden. Seventy-one family carers, 51 females (72%) and 20 (28%) males of long-term intensive care patients completed a mailed survey, after signing an informed consent form. Although the vast majority of the caregivers were providing substantial number of hours of care each week, they scored lower than the midpoint on all caregiver burden inventory subscales. Filial obligation was found to be positively associated with caregiver burden; however, there was no association between social support, self-efficacy and caregiver burden. Male caregivers experienced significantly more burden than female caregivers. The findings suggest that an understanding of the factors that impact on caregiver burden of families of ICU survivors is only beginning to emerge.

Informal caregiving dynamics with a case study in blood and marrow transplantation

PURPOSE/OBJECTIVES

To develop a definition of informal caregiving dynamics through a selective literature review and explore the proposed definition in the context of blood and marrow transplantation using a case study.

DATA SOURCES

Published articles.

DATA SYNTHESIS

Informal caregiving dynamics are commitment, expectations, and negotiation that move a dyadic informal caregiving relationship along an illness trajectory.

CONCLUSIONS

The proposed definition of informal caregiving dynamics is useful in explaining how an informal caregiving dyadic relationship develops and is sustained.

IMPLICATIONS FOR NURSING

Understanding the dynamics underlying informal caregiving relationships enables nurses to intervene effectively to develop and sustain these vital relationships. Elements of the concept require further clarification. Research to validate the accuracy of the concept is needed.