The experience of the family caregivers' role: a qualitative study

[What prevention potential does the general practitioner setting offer for family caregivers?-findings from a qualitative interview study]

The support of people in need of care and assistance is often provided by caring relatives. General practitioners can play an important role in supporting this group, if they adapt to the problems and wishes of family caregivers.The aim of the exploratory study is to contrast care needs of family caregivers regarding the GP support with actually experienced care and, thereby, work out approaches for strengthening the GP's role.A total of 37 family caregivers were recruited via 13 internet forums focused on caregiving. Telephone interviews were conducted between September 2020 and March 2021.The majority of those interviewed consider the GP to be an important support body with a high level of competence and trust. The interviewees praise the GP's knowledge of the personal care situation, the responsiveness to a wide variety of problems and the focus on those in need of care. However, communication about the caring activity is often delayed significantly (late identification and addressing of family caregivers). GPs do not always address the needs of relatives to the same extent as they do to those in need of care. Only some of the doctors refer caregivers to offers of help and support.GPs can play a central role in supporting family caregivers. An crucial prerequisite for this is that family caregivers are recognized and involved at an early stage. In addition, it is important that GPs take into account the needs, desires and stresses of both caregivers and those being cared for. Consistent references to offers of help make it easier for family caregivers to organize care and to receive (psychosocial) support.

Experiences of family caregivers of the older people with limitations in activities: A qualitative study

Functional disabilities increase with ageing and limitations in daily living activities (ADLs) occurred as a consequence. Older people living at home may therefore become dependent on family members in managing activities in daily living. As the informal caregivers' role is known to be challenging, their experiences need to be explored to strengthen their new roles as family caregivers. This study aimed at exploring family caregivers' experiences of providing care for older people living at home with limited ADLs in Sri Lanka. Caregivers caring for older people with limitations in activities at home were purposively selected. Limitations in ADL were determined using the Sinhala-validated Barthel Index. Data were collected through in-depth interviews with 20 caregivers who cared for older people with several basic self-care limitations. Data were analysed using thematic analysis. The results consist of three themes related to caring for older people with limited ADLs: committed to providing compassionate care for the activity-limited older person, trapped in one's own home by caring for the activity-limited older person and in need of respite and support in caring for older persons with limitations of activity. Motivated to care, adapting to care-giving challenges, changed life pattern, neglecting one's own health, emotional suffering, lack of knowledge and skills and wanting assistance in care-giving and with financial support were resultant subthemes. Family caregivers of older people with limited activities living at home, face many challenges to their own health. Supporting interventions will therefore be necessary. An introduction of educational training programmes for informal caregivers would promote the health and well-being of functionally disabled older people and their caregivers. Developing home-based care will be a future solution since the availability of informal caregivers will be at risk due to a rapid increase in older people and social changes related to the family structure.

Prerequisites for providing effective support to family caregivers within the primary care setting - results of a study series in Germany

Background

General Practitioners are considered to be well placed to monitor home-care settings and to respond specifically to family caregivers. To do this, they must be sensitive to the needs and expectations of caregivers. In order to determine the current status of GP care in terms of the support given to family caregivers, a series of studies were conducted to gather the perspectives of both caregivers and GPs. The results are used to derive starting points as to which measures would be sensible and useful to strengthen support offered to family caregivers in the primary care setting.

Methods

Between 2020 and 2021, three sub-studies were conducted: a) an online survey of 612 family caregivers; b) qualitative interviews with 37 family caregivers; c) an online survey of 3556 GPs.

Results

Family caregivers see GPs as a highly skilled and trustworthy central point of contact; there are many different reasons for consulting them on the subject of care. In the perception of caregivers, particular weaknesses in GP support are the absence of signposting to advisory and assistance services and, in many cases, the failure to involve family caregivers in good time. At the same time, GPs do not always have sufficient attention to the physical and psychological needs of family caregivers. The doctors interviewed consider the GP practice to be well suited to being a primary point of contact for caregivers, but recognise that various challenges exist. These relate, among other things, to the timely organisation of appropriate respite services, targeted referral to support services or the early identification of informal caregivers.

Conclusions

GP practices can play a central role in supporting family caregivers. Caregivers should be approached by the practice team at an early stage and consistently signposted to help and support services. In order to support care settings successfully, it is important to consider the triadic constellation of needs, wishes and stresses of both the caregiver and the care recipient. More training and greater involvement of practice staff in the support and identification of caregivers seems advisable.

[General practitioners, attitudes, procedures and challenges towards supporting family caregivers - results of a survey of primary care physicians]

BACKGROUND

 General practitioners are considered to be well suited when it comes to addressing the information and care needs of family caregivers. The aim of the present study is to examine how general practitioners assess their possibilities to support caregivers, what priorities they set and to what extent they experience challenges.

METHODS AND PARTICIPANTS

 In the course of an online survey with a postal cover letter, a total of 3,556 GPs in in Baden-Württemberg, Hesse and Rhineland-Palatinate were interviewed between February and June 2021. Due to the exploratory approach of the study, only a descriptive data analysis was carried out.

RESULTS

 68 % of the GPs surveyed often deal with family caregivers in everyday practice; 77 % consider the GP's office to be well suited as the primary point of contact for family caregivers and care coordination. Often it is caregiving relatives who ask the GP about the issue of care (89 %). Frequent contents concern a deterioration in the care situation (75 %) and a change in the need for care (84 %); consultations in the initial phase of care are less common (40 %). There are differences between urban and rural doctors in the perception of the needs of caregivers and the setting of priorities. Rural doctors give more weight to proactive and psychosocial care, whereas doctors in urban regions rely on the specialist and support network. GPs experience various challenges while supporting caregivers, including the timely organization of suitable relief offers (87 %), the referral to suitable offers of help (79 %) or the early identification of informal caregivers (59 %).

DISCUSSION

 GPs can play a central role in supporting family caregivers. A crucial prerequisite for this is that family caregivers are recognized and involved at an early stage. Consistent references to offers of help make it easier for family caregivers to organize care and to receive (psychosocial) support. In addition, it is important that GPs take into account the needs, desires and stresses of both caregivers and those being cared for.

Mirabegron Alleviates the Degree of Burden Experienced by Caregivers of Older Females with Mixed or Urge Incontinence: A Prospective Study

Purpose

Older people, especially women, have the highest known prevalence of urinary incontinence (UI) of any other age-group. Continual care provision for elderly incontinent females is an incredibly arduous process, yet only very few studies have investigated the issue. Aim of the study was to evaluate the impact of mirabegron’s treatment on the degree of burden experienced by caregivers of elderly female patients with UI.

Patients and Methods

A hundred and eighty-six caregivers of older females with mixed or urgency UI besides various conditions (strokes, post-operative recovery after major surgery, etc.) were included in the study. Group A comprised 91 patients that did not want to receive any treatment for UI. Group B consisted of 95 elderly females treated for UI with mirabegron 50 mg/daily for three months. All caregivers completed the Zarit Burden Scale (ZBS) questionnaire at the outset and after the three months. All patients completed a bladder diary at the beginning and at the end of the observation/medication period.

Results

Patients receiving mirabegron presented a statistically significant improvement in UI parameters. Their caregivers showed a statistically significant decrease in the ZBS total score as well as separate domains.

Conclusion

This pilot study confirms that mirabegron administration can improve the quality of life of older females suffering from UI while substantially relieving caregiver burden. Recognizing the physical and emotional reactions of caregivers may help health providers deliver better support and resources to meet the needs of caregivers and patients alike.

The impact of the absorbent products distribution system on family caregivers of older people with incontinence in Italy: perception of the support received

Background

Urinary incontinence is a chronic, age-related disorder, likely to increase in the future due to global population ageing. In Italy, as in most countries, older people with incontinence are often cared for by family caregivers, whose burden might be worsened by the perception of receiving an inadequate support, due to the lack of customized services. The aim of this study was to evaluate the impact of the absorbent products distribution method on family caregivers’ perception of the support received.

Methods

The study compared the distribution of pads to homes and in pharmacy via a survey reaching 101 family caregivers of older people with incontinence living in two geographical areas of the Marche Region (Central Italy) with different distribution systems. The association between “Quality of perceived support” (the outcome variable) and two types of absorbent products delivery methods (i.e. pharmacy and home distribution) was analysed by means of a general linear model.

Results

Findings show that family caregivers receiving pads at home (HODs) perceived a higher support than those gaining them at the pharmacy (PHADs) (respectively 68.1% vs 35%). The association between perceived support level and distribution system remained even after correction for confounding factors. 70.2% of PHADs reported “Poor well-being”, versus only 53.7% of HODs. The latter are more satisfied with the type of products distribution and thus less inclined to experiment different systems for the supply of products for the urinary continence (e.g. by voucher). The results are virtually reversed among PHADs and the difference is statistically significant (p <  0.001).

Conclusions

When family caregivers feel supported by a more customized service delivery system, their perception of the care-related burden is mitigated. Thus, it is important to consider the needs of both family caregivers and cared for older people, and not only of the latter for designing a more suitable distribution of absorbent products. The best solution could be leaving end-users the freedom to choose how they want to get products (e.g. voucher or personal budget). This requires a reorganization of the current pads delivery systems adopted by the Marche and by other Italian Regional Health Systems.

Crossing, Trudging and Settling: A phenomenological inquiry into lived experience of Asian family caregivers of older persons with dementia

Throughout Asian societies, family members often adopt the role of caregiving for older persons, providing essential care for loved ones with dementia. To date, there has been limited insight into the lived experience and meaning ascribed to the journey of these caregivers. This descriptive phenomenological study aims to explore the lived experience of Asian family caregivers of persons with dementia. Semi-structured face-to-face interviews were conducted with 16 family members caring for aged persons with dementia. Interviews were audio-recorded and data analysed using Colaizzi's technique. Analysis revealed the essential structure of a caregiver's journey with three major transitions, namely: (1) Crossing the threshold from ordinary world into caregiving world, (2) Trudging on the road of trials and obstacles, and (3) Settling into a new normalcy. Understanding the lived experience of Asian caregivers can help clinicians in targeting relevant support and information, and prepare new caregivers for the demands of their role.

Needs and preferences of informal caregivers regarding outpatient care for the elderly: a systematic literature review

BACKGROUND

Informal caregivers are an essential pillar for ensuring and maintaining the outpatient care of the frail elderly. Due to demographic changes, including an increase in the number of people in need of care as well as changing social structures (full-time employment of women, increasing number of single households, etc.) these informal care structures are fraught by considerable challenges. To support and facilitate informal caregivers in their role of nursing, it is important to identify their preferences, needs, and thus create a preference-oriented system.

METHODS

A systematic review was conducted to identify preferences and needs regarding the organization of informal care. The database searches were performed by using EMBASE, Scopus and Dimdi.

RESULTS

A total of 44 studies were included in the present review. Studies from 17 different countries provide broad international perspectives. Besides the preferences for long-term care structure, the following four principal topics were identified: (1) informational needs; (2) support needs; (3) organizational needs, and (4) needs for societal recognition.

CONCLUSION

To meet the current challenges in the outpatient or home-based care of elders, it is essential to strengthen the role of informal caregivers. Therefore, it is necessary to adopt and further develop informal care structures according to the needs of informal caregivers. However, demographic, financial and cultural aspects of each country need to be considered as these may influence the preferences and needs of informal caregivers.

Perspectives on the delegation of hygienic care in the context of home nursing: a qualitative study

BACKGROUND

In light of current trends and healthcare evolutions, delegation of patient care from home nurses to health care assistants (HCAs) is increasingly important. Hygienic care is an essential component of nursing education and practice, yet it has rarely been the subject of scientific literature.

AIM

To understand the opinions and experiences of home nurses and policy makers with regard to the meaning of hygienic care and the delegation of these acts in the context of home nursing.

METHODS

A descriptive qualitative study (six focus groups with home nurses and two with policy makers from the Belgian home nursing sector). Content analysis of the data and the use of NVivo 11.0 software.

FINDINGS

Hygienic care is a cyclical care process of continuously investing in a trusting relationship with a patient, assessing their care needs and ability for self-care and taking action and evaluating care as situations change. All of this must be mutally agreed with the patient and should consider their environment and lifestyle. The decision to delegate hygienic care is based on patient assessments and the patient's specific care needs using nursing diagnoses and indicators. Finally, barriers and facilitating factors for both delegating and providing hygienic care were addressed.

CONCLUSION

Hygienic care is a crucial component of nursing care, that can be delegated to HCAs with the necessary supervision.

Calidad de vida de los cuidadores de personas con enfermedad crónica

El alto impacto epidemiológico, social, económico y cultural de las enfermedades crónicas no transmisibles afecta el significado de calidad de vida en las personas que las padecen y en sus cuidadores familiares. Objetivo: describir la forma como se construye el significado de calidad de vida de cuidadores de personas con enfermedad crónica. Método: investigación desarrollada con la propuesta de metasíntesis cualitativa de Sandelowski y Barroso. Resultados: se presentan tres momentos en la trayectoria: 1) se afecta (destrucción celular programada); 2) se trasforma (autocontrol del desarrollo y crecimiento), y 3) se resignifica (condensación); y cuatro factores condicionantes para la construcción del significado de calidad de vida para el cuidador como son el soporte social, la espiritualidad, la habilidad para cuidar y el tiempo. Conclusiones: la calidad de vida se afecta y se reconstruye en virtud del significado que el cuidador tenga de esta.

'It is a Big Thing': Exploring the Impact of Osteoarthritis from the Perspective of Adults Caring for Parents - The Sandwich Generation

PURPOSE

The aim of the present study was to explore the experiences and impact of caring for an individual with severe osteoarthritis (OA) from the perspective of adult children, looking at the relationship between adult children caring for parents with this condition and the tensions of the 'sandwich generation'.

METHODS

A mixed qualitative approach, combining focus groups and individual semi-structured interviews was used. In total, 36 participants were purposively sampled and discussed the impact of caring for a parent with OA. Data analysis was based upon interpretative phenomenological analysis.

RESULTS

Findings reported the impact and complexity of caring for a parent with OA. We present three themes related to the work of caring for a relative with this condition: (i) the physical and emotional work of caring; (ii) changes in reciprocal family roles; (iii) the imbalance in caring roles within the family.

CONCLUSIONS

Participants described the significant and extensive impact on their lives of caring for a parent with long-term OA, particularly when faced with the pressures of caring for their own children as well. Copyright © 2016 The Authors Musculoskeletal Care Published by John Wiley & Sons Ltd.

Providing Care Beyond the Hospital: Perspective of a Tertiary Care Hospital from a Developing Country

BACKGROUND

Neurorehabilitation is an important aspect of continuing care for neurosurgical patients with functional disability. In developing countries, where formal home nursing frequently is unavailable, ensuring care after discharge is a difficult task. Training attendants to provide nursing care is an alternate option. In this study, we compared the outcomes of patients nursed by family members versus those looked after by a professional nurse.

METHODS

This was a retrospective observational study conducted at the Aga Khan University Hospital Karachi. The study consisted of 2 groups. Group 1 (consisting of patients cared for by a professional nurse) included 94 patients and group 2 (patients cared for by family members) included 102. All these patients had activity of daily living score of ≥3. Glasgow Outcomes Scale score, time to decannulation, development/worsening of bedsores, and mortality were recorded and compared between the groups at follow-up.

RESULTS

The study included 196 patients. Traumatic brain injury was the most common diagnosis. Nursing requirements were similar between the 2 groups and included tracheostomy care, percutaneous endoscopic gastrostomy tube care, peripherally inserted central catheter line care, care of patients with no bone flap, and log-rolling. The outcomes of the 2 groups were comparable and included bedsore development/worsening of grade, Glasgow Outcomes Scale score at follow-up, time to decannulation, and 30-day mortality.

CONCLUSIONS

There was no statistically significant difference in outcomes of patients nursed by family members compared with the patients looked after by professional nurses.

Enabling a family caregiver-led assessment of support needs in home-based palliative care: Potential translation into practice

BACKGROUND

Systematic assessment of family caregivers' support needs and integrating these into service planning according to evidence-based research are vital to improving caregivers' outcomes and their capacity to provide care at end of life.

AIM

To describe the experience with and feedback of nurses on implementing a systematic assessment of support needs with family caregivers in home-based palliative care, using the Carer Support Needs Assessment Tool.

METHODS

This study was conducted during 2012-2014 in Silver Chain Hospice Care Service in Western Australia. This article reports on one part of a three-part evaluation of a stepped wedge cluster trial. Forty-four nurses who trialled the intervention with 233 family caregivers gave their feedback via surveys with closed- and open-ended questions (70.5% response rate). Analyses of quantitative and qualitative data were undertaken.

RESULTS

The feedback of nurses was overwhelmingly positive in terms of perceived benefits in comparison to standard practice both from the family caregiver and service provider perspectives. Using the Carer Support Needs Assessment Tool was described by nurses as providing guidance, focus and structure to facilitate discussion with family caregivers and as identifying needs and service responses that would not otherwise have been undertaken in a timely manner.

CONCLUSION

Our study has successfully addressed the call for alternatives to the professional assessment paradigm using the Carer Support Needs Assessment Tool approach as a caregiver-led intervention facilitated by health professionals. Integrating the Carer Support Needs Assessment Tool in existing practice is fundamental to achieving better caregiver outcomes.

Impact of incontinence on the quality of life of caregivers of older persons with incontinence: A qualitative study in four European countries

The aim of this study was to assess the impact of incontinence management on informal caregivers of older persons with incontinence. In order to investigate this phenomenon in different welfare systems via qualitative interviews and a content analysis methodology, the study was carried out in four European countries (Italy, the Netherlands, Slovak Republic and Sweden). To this purpose, 50 semi-structured interviews were conducted with spouses and children of older people receiving their help to manage the consequences of involuntary urinary and/or faecal leakage. Findings show that incontinence has a remarkably strong effect on caregivers' quality of life, because it results in progressive social isolation, causing them financial problems as well as psychological and physical exhaustion. The lack of appropriate support and the general silence regarding the problem, which is still considered a taboo by many, aggravate the caregivers' situation. It is therefore crucial that caregivers can count on a strong public and private support network, appropriate information and suitable incontinent products, in order to better handle incontinence and care tasks in general.

Reconstruyendo el significado de calidad de vida de los cuidadores en el cuidado: una metasíntesis

<p>Las enfermedades crónicas no transmisibles afectan la calidad de vida de las personas que las padecen y de sus cuidadores familiares. Se ha demostrado que se cambian los estilos de vida, aparece el dolor y las limitaciones, se altera la socialización y surgen sentimientos de pérdida y muerte. Se requiere por esto hacer una revisión sistemática del conocimiento generado para construir teóricamente<br />el concepto de calidad de vida de los cuidadores familiares.</p><p><strong>Objetivo:</strong> Realizar una integración interpretativa a partir de la evidencia científica del fenómeno de calidad de vida de cuidadores de personas con enfermedad crónica.</p><p><strong>Método:</strong> Metasíntesis de 24 artículos publicados de investigaciones científicas del fenómeno de calidad de vida de cuidadores de personas con enfermedad crónica, de bases de datos electrónicas reconocidas en enfermería y salud a partir del método de Sandelowski y Barroso (2006).</p><p><strong>Resultados:</strong> Emergió un planteamiento hipotético denominado Reconstruyendo el significado de calidad de vida de los cuidadores en el cuidado que se sustenta en tres momentos  para el significado de calidad de vida: vivir en desasosiego,<br />vivir para la calidad de vida del otro y construir la propia calidad de vida.</p><p><strong>Conclusiones</strong>: La reconceptualización de la calidad de vida de los cuidadores genera en el cuidador una forma diferente de percibir su experiencia, la cual está condicionada por los asuntos morales que están asociados a la labor de ser cuidador y las opciones de desarrollo humano con el significado espiritual emergente. La construcción del significado de calidad de vida para el cuidador se da a través de la experiencia de cuidado, edificándose en el ejercicio de su rol de cuidador, el cual responde a factores estrechamente relacionados con lo moral y evoluciona tomando un significado espiritual.</p>

A comparison of the discursive practices of perception of patient participation in haemodialysis units

BACKGROUND

According to Norwegian law, nurses are obligated to provide an acceptable level of health assistance to patients and their family members and to allow patients and their family members to participate in the planning of patient care and treatment.

AIM

The aim of this study is to compare the perceptions of older patients undergoing haemodialysis treatment and of their next of kin and of nurses regarding patient participation in the context of haemodialysis treatment.

RESEARCH DESIGN

The study adopts an approach that is both comparative and explorative in nature by examining the narratives of patients, nurses and next of kin and by performing critical discourse analysis as outlined by Fairclough.

ETHICAL CONSIDERATIONS

Permission to carry out the research was granted by the Regional Committee for Medical and Health Research Ethics of Mid-Norway and by the participating hospitals. Informed consent and confidentiality were ensured.

FINDINGS

Two discourses were found: (a) the discourse of paternalism with the discursive practices of achieving physiological balance in patients, trusting the healthcare team and being excluded or included in the difficult end-of-life decision-making process, and (b) the discourse of patient participation, with the themes of maintaining patients' quality of life and trusting patients.

CONCLUSION

The participation of older patients and their next of kin was not as well integrated as social practice in dialysis units. The dominant discourse seemed to have an ideology and social practice of paternalism. However, there existed hegemonic struggles for an ideology of patient participation that involved (a) achieving physiological balance in patients versus maintaining patients' quality of life, (b) trusting the healthcare team versus trusting the patient, and (c) being excluded versus included in the difficult end-of-life decision-making process.

Undergraduate nursing students caring for cancer patients: hermeneutic phenomenological insights of their experiences

BACKGROUND

The care of patients suffering from cancer and especially those facing the death trajectory appears to be complex and demanding not only for student nurses but for professional nurses as well. The educational models often used in nursing require students to face challenging care scenarios, sometimes with minimal or no supervision and guidance. These "worst case scenarios" can be traumatic experiences that can leave the student hopeless and disappointed of themselves and in many cases can "scar" their subsequent professional career. The literature demonstrates that this can be the result of the students' ill-preparation to care for cancer patients and deal with death and dying. The purpose of this study was to interpret the students' experiences of coming face-to-face with cancer care during their clinical placements.

METHODS

This is a hermeneutic phenomenological study influenced by the ideas of the French Philosopher Paul Ricoeur. Based on this philosophical enquiry the interpretation process included three stages: 1) naïve reading, 2) structural analysis and 3) comprehensive understanding. Data were collected through reflective/narrative diaries from the 4th grade undergraduate (pre-registration) nursing students practicing at oncology, hematology, pediatric oncology departments and hospices. Diaries of twelve students met the inclusion criteria and were included in the interpretation process. The study took place during January and May 2011.

RESULTS

The interpretation yielded the following themes: a) Being part of the center's life, b) Being sympathetic, c) Being confronted by others, d) Being self-reflective, e) Being trapped in the system, f) Being caring towards the family and g) Being better in clinical practice.

CONCLUSIONS

The students emphasized the need for appropriate preparation both at a theoretical and at a clinical level, as to better confront situations involving death and dying as well as learning techniques for crisis management. The students perceived the importance of adopting a policy that is both patient and family-centered in order to provide better care.

Death representation of caregivers in hospice

In this study, we investigated caregiver's death representation in hospice. The results presented here are a further analysis of the data collected in our previous study, concerning the evaluation of the caregiver in hospice. The data analysis of 24 caregivers of patients hospitalized in Rimini Hospice (Italy) underlined that caregivers avoiding death representation of the patient admitted to hospice had fewer protective factors (52.3%) and more risk factors (47.7%) than caregivers nonavoiding (66.5% and 33.5%, respectively). Caregivers avoiding death representation, moreover, experienced a greater distress (58%) than those nonavoiding (42%).

The next of kin of older people undergoing haemodialysis: a discursive perspective on perceptions of participation

AIM

This paper is a report of a study conducted to explore how the family members of older people who will undergo haemodialysis treatment for the rest of their lives perceive participation.

BACKGROUND

The rights of families to participate in treatment and health care are supported by international law, and by national law in Norway since 1999.

METHOD

This study, which employed an explorative qualitative approach, was carried out in Norway in 2008. Data were derived from transcribed interviews with seven family members underwent critical discourse analysis.

FINDINGS

Three discourse practices about the next of kin perception of participation were found: (1) to care and take control, (2) to struggle for involvement, and (3) to be forgotten and powerless. The next of kin said that they had no dialogue with the healthcare team, and some fought to be included in the decision-making process.

CONCLUSION

The dominant part of the discourse as expressed by the next of kin seems to be a paternalistic ideology. Thus, finding ways to enable the next of kin to participate in the decision-making process seems to be a major challenge for the healthcare team in the dialysis units.

Living through end-stage dementia: The experiences and expressed needs of family carers

The focus of this paper is the experiences and needs of family carers of people with end-stage dementia. The project involved in-depth, qualitative interviews with 15 carers. The major themes emerging from the accounts of participants’ experiences were: getting support; having to trust others with care; managing the loneliness of being a carer; witnessing a loved one fade away; anticipating and experiencing death; and re-establishing life after the funeral. Carers expressed a range of instrumental and psychosocial needs. The study has provided a more personal account of the caring experience than much of the related literature. It has emphasized the need of carers for genuine understanding and connection — from family and friends as well as healthcare staff. The study highlights the amount of support carers can provide to each other through support groups and associated friendships, and stresses the importance of healthcare staff acknowledging and respecting this capacity of carers.

Strategies for the relief of burden in advanced dementia care-giving

AIM

This paper is a report of a study conducted to uncover the strategies that women caregivers of relatives with advanced dementia use to rest from care-giving.

BACKGROUND

Respite consists of activities and situations that briefly take caregivers away from their care-giving responsibilities. Qualitative studies are focusing on respite as an outcome and are deepening our knowledge about the experience of caregivers' rest. The strategies that caregivers use to relieve the burden, however, are not fully known.

METHOD

A qualitative approach was used influenced by the work of Charmaz's constructivist grounded theory. Twenty-three female primary caregivers of relatives with advanced dementia participated in semi-structured interviews between November 2006 and March 2009 in Spain. Data collection was guided by the emergent analysis and ceased when no more relevant variations in the categories were found.

FINDINGS

Taking leave from the life of care-giving is the general strategy that caregivers use to rest from their caregivers selves. The key issue is to be able to connect with a different world from that of care-giving. Three strategies that participants use to leave the life of care-giving follow: (1) Connecting with one's own life, (2) building moments of life in common with the sick relative and (3) keeping in touch with care-giving.

CONCLUSION

To have respite from care-giving implies distancing oneself from the care-giving identity and reveals the caregiver's need for alternative selves to have true breaks from caring. Nurses are in a unique situation to foster respite as an inner experience.

Impact of community care in enabling older people with complex needs to remain at home

Aim.  This aim of the study was to explore the impact of community care in enabling older people with complex needs to remain at home. Background.  Changing demographic trends and successive government policies have led to an increase in the number of older people with complex needs residing in the community. Design.  A qualitative approach using semi-structured interviews was used to collect data from older people (n = 17) and carers (n = 14). Method.  Social workers were asked to identify community dwelling older people (65+ years) with multiple needs requiring interventions from a range of health and social care practitioners. Results.  Community care enabled older people with complex needs who would otherwise have required residential or nursing home care to remain in their own homes. This was the expressed wish of both the older people and carers interviewed. Conclusions.  The provision of high-quality community care for older people is a globally significant challenge and one that requires creative solutions, both at a local and strategic level. Relevance to clinical practice.  Nurses and other health and social care professionals need to understand the significance of 'home' for older people and take steps to ensure that additional and appropriate resources are targeted towards community care.

Reactions of primary caregivers of frail older people and people with cancer in the palliative phase living at home

AIM

This paper is a report of a study conducted to (1) compare means of the single items and the dimensions of the Caregiver Reaction Assessment among caregivers of frail older people and caregivers of cancer patients in the palliative phase; (2) examine gender differences for the scoring parameters in the Caregiver Reaction Assessment within each group and (3) examine the demographic variables' association with the caregiver groups' scores for the dimensions of the Caregiver Reaction Assessment.

BACKGROUND

Limited research has focused on the caregiver situation in the home-care setting among primary caregivers of frail older people, and caregivers of patients with cancer in the palliative phase.

METHODS

A convenience sample of 224 caregivers of frail older people, and 85 caregivers of patients with cancer in the palliative phase was recruited between 2002 and 2005. We used the Caregiver Reaction Assessment to collect the data.

RESULTS

The mean scores for the Caregiver Reaction Assessment dimensions showed statistically significant differences between the two groups of caregivers for the factors self-esteem, family support, finances and health. For caregivers of frail older people, we found statistically significant associations between several demographic variables and the Caregiver Reaction Assessment dimensions. For caregivers of patients with cancer in the palliative phase, age was the only demographic variable that was statistically significantly associated with the dimensions.

CONCLUSION

Healthcare personnel should pay attention to how relatives experience their caregiver situation, and the Caregiver Reaction Assessment could be a valuable tool for gathering systematic data on this.

Experiences and challenges of informal caregiving for Korean immigrants

AIM

This paper is a report of a study designed to explore the caregiving experiences of Korean Americans.

BACKGROUND

Increasing numbers of older people in the Asian population place important long-term care demands on Asian caregivers, yet minimal attention has been given to the issue of caregiving in this group. The current study attempts to fill the gap by describing Korean American caregivers' unique caregiving experiences from their perspectives.

METHOD

A qualitative research design using a focus group approach was employed to discuss caregiving experiences in a cultural context. Data were collected over an 8-month period in 2005. Twenty-four informants, mostly women, at varying points surrounding caregiving participated in a focus group interview. Each focus group lasted about 1 (1/2)-2 hours. Thematic analysis was conducted by two bilingual researchers.

FINDINGS

Three key themes were identified: the caregiver role - competing priorities and beliefs, the extent and impact of caregiving, and the need for education and culturally-tailored support systems. Ten subthemes were identified within the three major themes: (1) facing double challenges; (2) changing attitudes about filial piety (Hyo); (3) providing care; (4) feeling out of control; (5) going through changing family dynamics; (6) being connected vs. providing connection; (7) paying back; (8) learning by themselves; (9) recognizing differences and (10) reconsidering geriatric care systems.

CONCLUSION

The caregiving experiences described by Korean American families point to the need to identify and develop more focused outreach programmes as well as more culturally appropriate support services for this rapidly increasing population.

Tactful monitoring: how thai caregivers manage their relative with schizophrenia at home

Approximately 343,680 individuals in Thailand suffering from schizophrenia are cared for at home by relatives, most of whom have a little knowledge of the disease; therefore they're left to develop their own strategies of care. Data were collected by in-depth interviews and observation involving 17 caregivers of relatives diagnosed with schizophrenia. Data were analyzed using the constant-comparative method of grounded theory. Caregivers' chief concern was avoiding psychotic episodes. They do this through a process we call "tactful monitoring," which includes the co-variables "unobtrusive observation" and strategies for calming. Caregivers follow a trajectory that leads them to a state of exhaustion, tired and sad, and fearful about the future care of their loved one. Findings from this study led the authors to conclude that in Thailand, caregivers were able to develop creative ways of tending to their relatives with schizophrenia at home, but not without significant cost to themselves. Limited provision for caregiver education and respite exists. If education and increased respite care were instituted, caregivers could benefit, and patients might avoid expensive inpatient visits.

Respite care--an explorative study of demand and use in Dutch informal caregivers

Recently, there has been increasing concern for the well-being of informal caregivers. Attention is directed at the development of respite care programs that provide support and relief by (temporarily) easing the burden for the caregiver. Yet, little is known about caregivers' needs, desires and use of respite care facilities. A survey was conducted among a population of informal caregivers, to investigate demand for and use of the four most common types of respite care, namely in-home respite care, day-care, short-stay and special holiday arrangements. The 273 caregivers that participated in this study were reasonably well informed about existing services, especially out-of-home services; least informed was a subgroup that needs but currently does not make use of respite. About one-third of caregivers made use of respite care. These caregivers experienced substantial burden and expected burden (60.7 on a 0-100 scale) to increase substantially in case respite care would no longer be available (+31 on a 0-100 scale). Caregivers and care recipients were generally satisfied with the respite care they receive. About half of the non-users indicated to need or desire respite care, in general those non-users experiencing a relatively high burden. The main impeding factor for use of respite care was care recipient resistance against respite (38%). A majority of carers (62%) anticipated that respite care could substantially decrease their subjective burden (-29 on a 0-100 scale). Mostly respite care facilities reach the caregivers most in need of support, but not all caregivers in need make use of respite. Improvements are possible in terms of information provision and focus on combined caregiver-care recipient needs and desires. More research is needed into the (cost-)effectiveness of respite care.

Subjective quality of life of family caregivers of community living Sudanese psychiatric patients

BACKGROUND

Reports on the quality of life (QOL) of family caregivers of psychiatric patients are uncommon.

OBJECTIVE

The objective of this study was to assess the subjective QOL of caregivers of stable Sudanese outpatients using the World Health Organization 26-item Quality of Life Instrument compared with a general population sample, and assess the factors associated with caregivers' QOL.

METHOD

Responses of caregivers of outpatients with schizophrenia (99), major affective disorders (120), and neuroses (81) were compared with 211 general population subjects.

RESULTS

Caregivers were satisfied with the items related to the strengths of the traditional society and dissatisfied with the items related to national economic indices. Schizophrenia caregivers had lower scores than the others (P > 0.05) who scored significantly higher than general population subjects and patients. Parents had the least scores. Patients' variables were not significantly associated with caregivers' QOL. Caregivers' sociodemographic variables were significantly associated with QOL. Caregivers' QOL was predicted by their impression of patients and state of health. Schizophrenics had the least correlations with caregivers' QOL.

CONCLUSION

Caregivers who are women, parents, and sick seemed relatively vulnerable and need assistance. Their areas of dissatisfaction with material circumstances should be addressed in a social welfare program. Caregivers' inner strengths, extended family supports, and positive appreciation of the patients are resources for enhancing their caregiving role.

A hybrid qualitative method for pretesting questionnaires: The example of a questionnaire to caregivers of Alzheimer disease patients

A hybrid method based on cognitive interviewing and consensus panels was developed to pretest a questionnaire for caregivers of persons with Alzheimer disease (AD). The objective of the questionnaire was to elicit caregivers' attitudes and opinions on the use of medications to treat the disease. Thirty-one caregivers were divided into five pretest groups, within which each participant was asked to comment on questionnaire wording and design. The comments from participants in the first three groups were used to revise the questionnaire, and the revised version was given to participants in the remaining two groups. Overall, 81% (118/146) of the participants' comments were implemented. The number of comments made in the last two groups decreased relative to the number of comments made in the first three groups. The hybrid method enhanced the user-friendliness of the questionnaire and can serve as an alternative to common ad hoc pretest approaches that have little basis in theory.