"At wits' end!": perspectives of Hispanic caregivers of a family member with schizophrenia

Needs, challenges, and coping strategies among primary caregivers of schizophrenia patient: A systematic review & meta-synthesis

INTRODUCTION

Deinstitutionalization and rising psychiatric care in society have led to an increase in the role of caregivers of persons diagnosed with schizophrenia.

OBJECTIVE

The objective of this systematic review was to identify and synthesize qualitative research findings that explored the needs, challenges, and coping strategies among the primary caregivers of a schizophrenia patient.

METHODOLOGY

The electronic databases namely PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Scopus, Web of Science, ProQuest, and ClinicalKey were searched to identify relevant articles published from 2005 to October 2021. The quality of the included articles was independently appraised by two reviewers using Walsh and Downe criteria and was analysed thematically. The meta-synthesis was modelled on Lucas framework.

RESULTS

The richness of information across 38 papers involving 543 participants was noteworthy. The needs of the primary caregivers were rehabilitation and vocational centre, information and education, self-help groups, augmented healthcare services, and communication and collaboration. The challenges reported were treatment expenses, bizarre beliefs, self and other directed harm and violence, therapeutic noncompliance, onerous caregiving task, crumbling family relations, misconception and discrimination, and self-stigmatization. The coping strategies adopted were problem-focused coping, emotional coping, behavioural coping, coping through social support, religious coping and cognitive reappraisal.

CONCLUSION

The primary caregivers provide unparalleled service to the health system and for the patient. The healthcare providers need to give undue attention to the unmet needs and challenges of the caregivers, which would benefit the health system by enabling the caregivers in providing long-term care for the schizophrenic.

Spiritual aspects of the family caregivers' experiences when caring for a community-dwelling adult with severe mental illness: A systematic review of qualitative evidence

WHAT IS KNOWN ON THE SUBJECT?: Being a caregiver of a relative with severe mental illness often impacts the quality of life, physical and mental health. The use of coping strategies related to spirituality can enhance physical and mental well-being. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This review found 26 primary studies that refer to spiritual aspects of the experience of caring for a relative with mental health problems. Caregivers express spiritual needs, such as hope and finding meaning in life, and spiritual or religious practices that help to cope with stressful situations. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Spiritual needs and spiritual coping strategies of family caregivers of a relative with severe mental illness should be included in mental health nursing care. A spiritually sensitive approach should be used when promoting coping strategies of the family caregivers of a relative with severe mental illness. ABSTRACT: Introduction Deinstitutionalization of individuals with severe mental illness transferred the responsibility of care to the relatives who need to adapt their personal life. Caregivers often develop coping strategies which involve the relationship with oneself, others, or the transcendent/God or nature and may include religious/spiritual practices. Question/Aim This review aims to identify the spiritual aspects of the family caregivers' experiences when caring for a community-dwelling adult with severe mental illness. Method The review was conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of qualitative evidence. Search was conducted in March 2019, updated in August 2020, limited to English, Spanish and Portuguese. Results A total of 26 studies were included. Two synthesized findings emerged: spiritual coping strategies are used by family caregivers; spiritual needs are expressed by family caregivers. The findings are based on the experiences of 467 caregivers, from 14 countries. Discussion In stressful times, family caregivers question the meaning in life and acknowledge hopelessness. To cope, caregivers mention a turn to the sacred and the use of spiritual/religious practices. Implications for practice Spirituality should be considered according to caregivers' individual beliefs and needs, as may represent important resources for the sense of meaning and overall well-being.

Ecological Systems Affecting Urban Childbearing Puerto Rican Women in the City of Philadelphia

OBJECTIVES

The purpose of this study was to explore socio-ecological influences affecting the daily lives of urban, pregnant Puerto Rican women and factors negatively influencing their health seeking behaviors related to prenatal care.

METHODS

Qualitative, descriptive methods were used including individual interviews and focus groups to obtain maximum understanding of the women's lives. The interviews and focus groups were conducted using a semi-structured interview guide based on various components of the study's conceptual framework. Content analytic strategies included rigorous and systematic processes to increase trustworthiness: training, supervision, audits, electronic technologies, and ongoing input of the research team.

RESULTS

Factors on all levels of the study's conceptual framework compound the effects of stressors and restrictions on the lives of urban, childbearing Puerto Rican woman. The intersectionality of issues for Puerto Rican women can either mitigate or heighten the pressure on their daily lives.

CONCLUSIONS

This initial research sets the groundwork for further studies, such as narrative analysis, to better understand how to build appropriate and relevant interventions. Uncovering the women's stories gives them the opportunity to be a critical part of cross-sector partnerships towards the development of sustainable interventions.

A Qualitative Systematic Review of Caregivers' Experiences of Caring for Family Diagnosed with Schizophrenia

Objective: To synthesise qualitative research that explored caregivers' experiences of caring for family diagnosed with schizophrenia.Methods: Electronic databases including PsycINFO, PubMed, CINAHL and Scopus were searched to identify relevant journal articles published from 2000 to March 2019. Quality was assessed and thematic synthesis of the qualitative research evidence undertaken. Papers were screened and independently appraised by two reviewers using The Critical Appraisal Skills Programme (CASP) for Qualitative Studies Checklist. The review was guided by Thomas and Harden's framework for thematic synthesis of qualitative research evidence.Results: The breadth of information across the 43 papers was noteworthy. Review of the findings noted that almost all of what was discussed fell into three broad themes: the 'feelings' of the caregiver towards their role, the patient and others, including the health system; the 'impacts' of the diagnosis and their caregiving role on the caregiver; and the 'needs' of the caregiver to improve the patient's quality of life and thereby the caregiver's quality of life. Within needs also came recommendations for future changes.Conclusion: Studies have shown that the caregiving process is a complex one, with both negative and positive emotional reactions, societal barriers, such as stigma and isolation, and unmet needs, such as timely, relevant and helpful information. Meeting the needs identified by caregivers has the capacity to address the impacts of the illness and caregiving and thereby reduce the negative feelings associated with the caregiver role.

Engagement of Urban, Pregnant Puerto Rican Women in Health Disparities Research

Persistent challenges surround the recruitment of minority women from marginalized communities in health disparities research. These challenges include lack of the following: interest in research participation, trust, positive relationships between researchers and participants/community, and principal investigators from minority groups. The purpose of this article is to describe successful recruitment strategies used in health disparities research with pregnant Puerto Rican women and to suggest ways to ensure the future success of studies on health disparities. Suggested strategies include creating trust, facilitating active participation of stakeholders, and strengthening the research pipeline with undergraduate and graduate nursing students.

Hispanic Mothers' Experiences with School-Based Emotional Health Curriculum and Perspectives of Their Own Mental Health Needs

An Emotional Health Curriculum (EHC) was developed to promote positive mental health in primarily Hispanic elementary school-aged children. In order to further expand the EHC, the mothers' experiences with the curriculum were examined. Eighteen mothers participated in two focus groups. Mothers reported that they valued this curriculum as a preventive program. Importantly, all mothers wished to extend their involvement to not only assisting their child in completing the curriculum homework but also attending a proposed parenting program. This study provides preliminary evidence that mothers embraced the EHC as an accessible community mental health service for their children and sought greater involvement.

Positive and negative impacts of schizophrenia on family caregivers: a systematic review and qualitative meta-summary

PURPOSE

Schizophrenia places a heavy burden on the individual with the disorder, as well as on his or her family; this burden continues over the long course of the disease. This study aimed to provide an overview of the positive and negative impacts of schizophrenia on family caregivers.

METHODS

From April to June 2017, two investigators conducted a systematic review and meta-summary of studies obtained from five electronic databases and the footnotes and citations of eligible studies. Qualitative studies that explored the experiences of family caregivers of individuals with schizophrenia were included. Study findings published between 1993 and 2017 were extracted and synthesised using narrative and summative approaches.

RESULTS

After the removal of duplicates, independent reviewers screened 864 records. Subsequently, 46 full-text articles were assessed for eligibility and 23 papers were included in the synthesis. Negative impacts identified were traumatic experiences, loss of expectation of life and health, lack of personal and social resources, uncertainty and unpredictability, family disruption, conflict in interpersonal relationships, difficulty in understanding, and stigma and heredity. Meanwhile, the positive impacts identified were family solidarity, admiration, affirmation, affection, compassion, learning knowledge and skills, self-confidence, personal growth, and appreciation.

CONCLUSIONS

Analysis of the studies suggested that family members of individuals with schizophrenia face a series of traumatic situations during the course of the illness. Their subsequent experiences can be conceptualised as a continuous circle of caregiving, in which the positive impacts can be centrally positioned within the negative impacts.

Developing a Multiple Caregiver Group for Caregivers of Adolescents With Disruptive Behaviors

This article describes the development of a 6-week multiple caregiver group intervention for primary caregivers of adolescents diagnosed with Oppositional Defiant Disorder or Conduct Disorder in low-income African American families. The intervention is aimed at increasing the primary caregivers' self-efficacy in managing interactions within the family and especially with child serving educational, mental health, juvenile justice, and child welfare systems. Development of the intervention involved seven iterative activities performed in a collaborative effort between an interdisciplinary academic team, community engagement specialists, members of the targeted population, and clinical partners from a large public mental health system. The intervention development process described in this article can provide guidance for teams that aim to develop new mental health interventions that target specific outcomes in populations with unique needs.

Schizophrenia in a member of the family: Burden, expressed emotion and addressing the needs of the whole family

How often do we find ourselves concentrating so much on treating a patient with schizophrenia that we forget about the needs and difficulties of the family members who take care of that patient? This article highlights the global and specific difficulties that families and caregivers experience in having to care for chronically ill family members with schizophrenia with a backdrop of continuing global deinstitutionalisation of such patients. Matters such as burden and expressed emotion are explored, family-specific interventions are discussed and areas of service delivery and resource inadequacies are identified.

Latinas and Intergenerational Caregiving: An Integrative Review of the Literature

BACKGROUND

Identifying gaps in the literature regarding Puerto Rican childbearing women and intergenerational caregiving will facilitate future nursing practice and research regarding the amelioration of poor maternal-fetal outcomes.

METHOD

A literature search using PubMed and CINAHL, sensitized by Bronfenbrenner's Ecological-Environmental Model on Latinas and intergenerational caregiving, generated 18 peer-reviewed research articles (2009-2014) for analysis.

RESULTS

Categories and themes included the following: Latinas are the primary caregivers within their families and communities; caregiving is described; however, none of the studies classified caregiving as intergenerational and none sought to understand the overall impact on Latinas simultaneously caring for other members of their caregiving networks.

CONCLUSION

Gaps in the literature need to be addressed to facilitate design of health care programs to address disparities and increase supports for childbearing Latinas involved in intergenerational caregiving who are at risk for higher incidences of challenging life experiences.

Understanding the perspectives of family members on telephone intervention for individuals with schizophrenia: results of a focus group

The current study explored the perspectives of family members of individuals with schizophrenia to identify family needs. Six family members from the National Alliance on Mental Illness participated in a 90-minute focus group to share their perspectives on treatment needs and delivery options and to provide suggestions on needs that might be met using telephone-based treatment. Traditional atheoretical content analysis was performed. Five major themes emerged from the data: (a) isolation, (b) negative emotions, (c) recognition of illness, (d) communication with providers, and (e) problem solving. Findings indicate that families perceive needs that could potentially be met using telephone-based treatments. More research is needed to determine family responses to telephone-based treatment initiatives.