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Aydin M, Bulut TY, Avcİ İA. Adaptation of Caregivers of Individuals on Mechanical Ventilation to Caregiving Role. Indian J Crit Care Med 2024; 28:41-47. [PMID: 38510765 PMCID: PMC10949279 DOI: 10.5005/jp-journals-10071-24596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/06/2023] [Indexed: 03/22/2024] Open
Abstract
Aim The aim of this study is to investigate the adaptation of caregivers of individuals on mechanical ventilation (MV) at home to their caregiver role. Study design The phenomenological research method, one of the qualitative research methods, was employed in the study. Materials and methods The sample consisted of 21 individuals who agreed to participate in the research. Necessary legal permissions were obtained to conduct the study. Results The data were analyzed according to the Roy adaptation model (RAM). Accordingly, the domains of the RAM were expressed with the following themes: Physiologic domain: The effects of care on the caregiver (reluctance toward self-care, psychological fatigue, insomnia, and limitation of social life); Self-concept domain: Supportive situations (trust in God and spiritual practices) and non-supportive situations (fear of losing and self-blame); Role-function domain: Adaptation of the caregiver role (thinking no one else can give similar care) and maladaptation of the caregiver role (fear of failing to cope with suddenly emerging situations, failing to fulfill roles and responsibilities, and economic inadequacy); Interdependence domain: Receiving support (support of healthcare professionals and support of family members) and lack of support (inadequacy of health services and loneliness). Conclusion It was concluded that individuals who provided care for patients on MV experienced many difficulties and that these difficulties increased their care burden and made it difficult to adapt to their caregiving roles. How to cite this article Aydin M, Bulut TY, Avcİ İA. Adaptation of Caregivers of Individuals on Mechanical Ventilation to Caregiving Role. Indian J Crit Care Med 2024;28(1):41-47.
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Affiliation(s)
- Mesiya Aydin
- Department of Public Health Nursing, Division of Nursing, Faculty of Health Science, Ondokuz Mayıs University, Samsun, Turkey
| | - Tuba Yilmaz Bulut
- Department of Public Health Nursing, Faculty of Health Science, Kocaeli University, Kocaeli, Turkey
| | - İlknur Aydin Avcİ
- Department of Public Health Nursing, Division of Nursing, Faculty of Health Science, Ondokuz Mayıs University, Samsun, Turkey
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Sun Y, Iwagami M, Sakata N, Ito T, Inokuchi R, Komiyama J, Kuroda N, Tamiya N. Evaluation of enhanced home care support clinics regarding emergency home visits, hospitalization, and end-of-life care: a retrospective cohort study in a city of Japan. BMC Health Serv Res 2023; 23:115. [PMID: 36737771 PMCID: PMC9898920 DOI: 10.1186/s12913-023-09088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To meet the increasing demand for home healthcare in Japan as the population ages, home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in 2006 and 2012, respectively. This study aimed to evaluate whether enhanced HCSCs fulfilled the expected role in home healthcare. METHODS We conducted a retrospective cohort study using linked medical and long-term care claims data from a municipality in Japan. Participants were ≥ 65 years of age, had newly started regular home visits between July 2014 and March 2018, and used either conventional or enhanced HCSCs. Patients were followed up for one year after they started regular home visits or until the month following the end of the regular home visits if they ended within one year. The outcome measures were (i) emergency home visits at all hours and on nights and holidays at least once, respectively, (ii) hospitalization at least once, and (iii) end-of-life care, which was evaluated based on the place of death and whether a physician was present at the time of in-home death. Multivariable logistic regression analyses were conducted for the outcomes of emergency home visits and hospitalizations. RESULTS The analysis included 802 patients, including 405 patients in enhanced HCSCs and 397 patients in conventional HCSCs. Enhanced HCSCs had more emergency home visits at all hours than conventional HCSCs (65.7% vs. 49.1%; adjusted odds ratio 1.70, 95% CI [1.26-2.28]), more emergency home visits on nights and holidays (33.6% vs. 16.7%; 2.20 [1.55-3.13]), and fewer hospitalizations (21.5% vs. 32.2%; 0.55 [0.39-0.76]). During the follow-up period, 229 patients (152 patients in enhanced HCSCs and 77 patients in HCSCs) died. Deaths at home were significantly more common in enhanced HCSCs than in conventional HCSCs (80.9% vs. 64.9%; p < .001), and physician-attended deaths among those who died at home were also significantly more common in enhanced HCSCs (99.2% vs. 78.0%; p < .001). CONCLUSIONS This study confirms that enhanced HCSCs are more likely to be able to handle emergency home visits and end-of-life care at home, which are important medical functions in home healthcare. Further promotion of enhanced HCSCs would be advantageous.
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Affiliation(s)
- Yu Sun
- grid.20515.330000 0001 2369 4728Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan ,grid.20515.330000 0001 2369 4728Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Masao Iwagami
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan. .,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
| | - Nobuo Sakata
- grid.20515.330000 0001 2369 4728Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan ,grid.20515.330000 0001 2369 4728Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tomoko Ito
- grid.20515.330000 0001 2369 4728Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Ryota Inokuchi
- grid.20515.330000 0001 2369 4728Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan ,grid.20515.330000 0001 2369 4728Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Jun Komiyama
- grid.20515.330000 0001 2369 4728Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan ,grid.20515.330000 0001 2369 4728Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Naoaki Kuroda
- grid.20515.330000 0001 2369 4728Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan ,Health Department, Tsukuba City, Ibaraki, Japan ,grid.416859.70000 0000 9832 2227Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Nanako Tamiya
- grid.20515.330000 0001 2369 4728Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan ,grid.20515.330000 0001 2369 4728Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Sun Y, Iwagami M, Komiyama J, Sugiyama T, Inokuchi R, Sakata N, Ito T, Yoshie S, Matsui H, Kume K, Sanuki M, Kato G, Mori Y, Ueshima H, Tamiya N. The Effect of Home Care Support Clinics on Hospital Readmission in Heart Failure Patients in Japan. J Gen Intern Med 2023. [PMID: 36650335 DOI: 10.1007/s11606-023-08030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Heart failure is common and is associated with high rates of hospitalization. Home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in Japan in 2006 and 2012, respectively. OBJECTIVE This study aimed to examine the effect of post-discharge care by conventional or enhanced HCSCs on readmission, compared with general clinics. DESIGN Retrospective cohort study using the Japanese nationwide health insurance claims database. PARTICIPANTS Participants were ≥65 years of age, admitted for heart failure and discharged between July 2014 and August 2015 and received a home visit within a month following the discharge (n=12,393). MAIN MEASURES The exposure was the type of medical facility that provides post-discharge home healthcare: general clinics, conventional HCSCs, and enhanced HCSCs. The primary outcome was all-cause readmission for 6 months after the first visit; the incidence of emergency house calls was a secondary outcome. We used a competing risk regression using the Fine and Gray method, in which death was regarded as a competing event. KEY RESULTS At 6 months, readmissions were lower in conventional (38%) or enhanced HCSCs (38%) than general clinics (43%). The adjusted subdistribution hazard ratio (sHR) of readmission was 0.87 (95% CI: 0.78-0.96) for conventional and 0.86 (0.78-0.96) for enhanced HCSCs. Emergency house calls increased with conventional (sHR: 1.77, 95% CI:1.57-2.00) and enhanced HCSCs (sHR: 1.93, 95% CI: 1.71-2.17). CONCLUSIONS Older Japanese patients with heart failure receiving post-discharge home healthcare by conventional or enhanced HCSCs had lower readmission rates, possibly due to compensation with more emergency house calls. Conventional and enhanced HCSCs may be effective in reducing the risk of rehospitalization. Further studies are necessary to confirm the medical functions performed by HCSCs.
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