The relationship between burden and well-being among caregivers of Italian people diagnosed with severe neuromotor and cognitive disorders

In studies on caregiving, high levels of perceived burden are commonly considered as synonymous with poor well-being. This study aimed at better disentangling the relationship between burden and well-being dimensions through their joint investigation. To this purpose, perceived well-being and social resources were evaluated among caregivers reporting different levels of burden. Participants were 91 caregivers (mean age=50.4; SD=9.6), parents of people diagnosed with severe neuromotor and cognitive disorders. Participants completed a semi-structured interview and a set of scaled questionnaires: Caregiver Burden Inventory (CBI), Satisfaction with Life Scale, Positive and Negative Affect Schedule, Depression Anxiety Stress Scale, Eudaimonic and Hedonic Happiness Investigation, Resilience Scale for Adults, and Multidimensional Scale of Perceived Social Support. Participants were divided into two groups according to their perceived burden level, assessed through CBI. In both groups, the subjective components of burden accounted for the major fraction of the total burden level. Participants perceiving high burden reported higher levels of depression related emotions, lower life satisfaction and lower resilience than participants perceiving low burden. No group difference emerged in perceived meaningfulness and social support. A regression analysis showed that the best predictor of perceived burden was life satisfaction, followed to a lesser extent by resilience, while depression related emotions did not provide significant contribution. Findings suggest that the joint assessment of burden and well-being dimensions, that are co-existing in caregivers' experience, allow for the identification of personal and relational resources that can be usefully included in interventions addressed to caregivers.

Who are the children using hospice care?

PURPOSE

The purpose was to examine the characteristics of children who use hospice care.

DESIGN AND METHODS

Using the Andersen Model of Health Services Use, California Medicaid administrative databases were analyzed to describe the characteristics of 76 children in hospice.

RESULTS

The predisposing, enabling, and need characteristics of children were identified. Children who used hospice were a diverse group with community resources that enabled them to access care while presenting with serious health needs. Children enrolled in hospice were more likely older (15-20 years of age), resided nearer a pediatric hospice, and had a serious health condition such as neuromuscular disease with multiple comorbidities.

PRACTICE IMPLICATIONS

With this knowledge, pediatric nurses can improve their clinical practice by targeting conversations with families and children most in need of hospice care.

[The management of neuromuscular diseases in the home]

Neuromuscular diseases often present complex problems with regard to their management of which health care professionals are not always aware. Nurse/patient cooperation respecting the skills and abilities of each party is necessary in order for the patient to live at home despite what are often severe disabilities.

[Analysis of the nursing role in the care of patients with neuromuscular disorders]

The nursing role in neuromuscular disorders has been shown as a promising solution in service organization. However, the role of neuromuscular nurses has scarcely been addressed in the literature. The present evaluation process was geared toward defining nursing role in relation to systematic follow-up of neuromuscular disorders and to assess its theoretical background.

Home non-invasive ventilation: a brief guide for primary care staff

An increasing number of patients with a wide range of respiratory problems are using non-invasive ventilation (NIV) at home to optimise their respiratory function. It has been estimated that in 1999 between 2,500 and 3,000 people in the UK (5 per 100,000 head of population) were using domiciliary NIV (Leger, 2001). As a consequence, health professionals working in the community are now more likely to encounter patients using this type of ventilation.

[Terminal care in the Department of Neurology]

Patients in the Department of Neurology undergoing treatment for disorders such as cerebrovascular disease, dementia, metabolic disease, neuromuscular disease and intractable disease, are included as subjects requiring terminal care. Intractable diseases ware defined by the Ministry of Health and Welfare (Ministry of Health, Welfare and Labor) in 1972 as being of unknown etiology, untreatable, chronically progressive and sometimes worsened by the care provided when nursing these patients. Intractable diseases in the Department of Neurology rank with those seen in other departments. Amyotrophic lateral sclerosis is the most difficult to treat due to the lack of effective drugs. On the other hand, Parkinson disease is the most treatable among intractable diseases in the Department of Neurology with the appearance of several new effective drugs. TRH (thyrotropin releasing hormone) is effective for ataxic gait in some patients with spinocerebellar degeneration. In the terminal care of intractable diseases in the Department of Neurology, common problems such as disturbances of swallowing, respiration and speaking develop in almost all patients and measures must be taken to treat these disturbances. Artificial respiration must be considered for respiratory distress. Artificial feeding by intubation must be considered for swallowing disturbance. All kinds of communication aids must be considered for speaking difficulties. The medical and nursing care team needs to manage these problems with consideration of the quality of life of the patients and their families as well as the complication of the diseases.

Botulinum toxin: a deadly substance with great therapeutic effect

Injections of botulinum toxin are commonly associated with cosmetic improvements. However, BTX is also used therapeutically to treat patients with neuromuscular and neurological disorders. Therapy is primarily carried out in outpatients as part of a wider management regimen, so it is vital for nurses to not only be aware of how BTX works but also of its deadly toxic properties.

[Survival with artificial respiration at home. An open, prospective study on home ventilation for neuromuscular diseases, in particular, the situation of ALS patients]

A growing number of patients with neuromuscular disease have been treated with home mechanical ventilation during the past 15 years. We prospectively examined the long-term effects and complications of this method, particularly with regard to noninvasive positive pressure ventilation (NPPV). Thirty-one patients with amyotrophic lateral sclerosis (ALS, n = 20) or other slowly progressive neuromuscular diseases (NMD, n = 11) were observed for 17,517 home ventilation days (almost 48 ventilation years). The mean observed ventilation time was 565 days (min/max: 30/2930). Twenty-five patients were ventilated noninvasively with different masks. The calculated mean survival with NPPV ventilation (criteria: death, tracheostomy, or patient deciding to break off) was 2052 (SE: +/- 317.8) days in the NMD group, 248 days (+/- 35.7) for ALS patients without bulbar symptoms, and 82 days (+/- 27.4) with bulbar paralysis. Complications with the need for intervention were observed six times more frequently with ALS than with NMD. NPPV is effective for years in patients with slowly progressing NMD. Those ALS patients without bulbar symptoms can profit for up to a year from NPPV, while those with bulbar paralysis can have some symptom relief. Complications of every kind are much more frequent in ALS patients.

Perioperative considerations for patients with musculoskeletal and neuromuscular disorders

This article first presents a brief description of musculoskeletal disease, then the anesthetic drugs that can trigger distress, and finally recommendations for perioperative nursing care based on pathophysiology and preservation of strength and function. The administration of a variety of anesthetic agents can exacerbate symptoms or result in unpredictable untoward effects on patients with musculoskeletal disease. Neuromuscular diseases result in diminished muscle strength. These deviations in structure and function must be considered when drafting a successful plan of care.

Soft tissue manipulation: neuromuscular and muscle energy techniques

Muscle rigidity and spasms occur with neurological disease and may contribute to contractures and shortening of muscle fibers that can interfere with motor behaviors, such as ambulation, or activities of daily living, such as combing hair, feeding or dressing. The neuromuscular technique (NMT) and muscle energy technique (MET) are nursing interventions that can reduce pain and muscle rigidity, lengthen muscle fibers and increase range of motion necessary for normal motor behavior. Nurses can use these techniques in patients with acute neurological diseases and those recovering in rehabilitation and long-term care settings. With some neurological diseases, muscle rigidity, increased muscle tone and muscle spasms reduce the range of motion of joints and the quality of movement. These changes often lead to contractures and impairments in performing daily tasks or ambulating, and thus, to loss of independence. Soft tissue manipulation can be used to reduce muscle tension and spasms, reduce pain and enhance the range of motion of joints whose function depends on the involved muscles. Soft tissue manipulation may also improve movement during specific tasks. Although the muscle relaxation achieved with manipulation techniques is primarily short-term, long-term effects occur. This article describes two techniques of soft tissue manipulation, their mechanisms of action, assessment and implementation. A case study is used to illustrate application of the techniques and possible long-term effects.

Neurodegenerative diseases: sustaining hope

The concept of hope is associated with coping and adaptation. Maintenance of hope is a fundamental part of neuroscience nursing. Hope and coping must be important areas of concern to nurses working with patients who have neurodegenerative disorders.

[Life quality of patients with muscular failure, using permanent respiratory support, seen from their point of view. 2. Practical requirements and problems connected with respirator treatment]

Sixteen patients with neuromuscular disease receiving long-term assisted ventilation participated in a combined questionnaire/interview investigation with the purpose of illustrating their situation as regards appropriate personal attention, technical aids, knowledge of respirator-technique, illness and regular hospital examinations, multidisciplinary conferences, adapted housing and speech problems connected with tracheostomy. Generally, we conclude that these practical factors and arrangements, enabling the patient to manage everyday life, were, on the whole, satisfactorily settled. Compliance with the patient's desires to the utmost extent is recommended and achievement of the optimal solutions for him, by means of teamwork. Thus one must always bear in mind that the goal of these practical arrangements for the patient (such as personal attention, technical assistance, hospital examinations etc.) apart from optimal maintenance of daily activities should be to keep the patient independent of residential care.

Outcome of home care for technology-dependent children: success of an independent, community-based case management model

Case management is important for successful home care of technology-dependent, respiratory-disabled children. Traditionally, the medical model of hospital-based home care and case management has been used for these children. The outcome may be different from when using independent, community-based home care and case management. We evaluated the results of 28 technology-dependent children [23 receiving mechanical ventilation and 5 receiving continuous positive airway pressure (CPAP)] from 8 hospitals, who utilized an independent, community-based, case management group to coordinate home care. After 26.3 +/- 20.6 months of follow-up, 13 children (46%) remained technology-dependent, 10 (36%) were technology-independent, and 5 (18%), all with neurologic dysfunction, had died. Only one death was caused by a complication of technology. All children with congenital anomalies (n = 4), primary pulmonary disease (n = 8), and neuromuscular disease (n = 4) survived, and 9 (56%) were weaned from technological support. Children with chronic respiratory failure secondary to central neurologic dysfunction (n = 12) did poorly: 5 died, 6 remained technology-dependent, and only 1 became independent of technology. Children with neuromuscular diseases tended to use less home care nursing at a lower home care cost. Parent satisfaction was high among those who responded (82%), indicating that the child, siblings, and family were better off with the child at home. These outcomes suggest that community-based home care and case management is a reasonable alternative to the hospital-based model.

[Neuromuscular disorders]

In this study, the author focuses on three neuromuscular disorders that have historically been isolated to a specific region in Québec. The author is convinced that appropriate nursing interventions can help in the detection of these disorders and can, using data on social behavior, help eliminate harmful genetic mutations.

Ineffective airway clearance related to neuromuscular dysfunction

Individuals with neuromuscular dysfunction are at increased risk for secretion retention. Their underlying disease process compromises or prevents ability to cough effectively. Although their lung function may remain normal, neuromuscular disease predisposes to breathing at low lung volumes and to elimination of sighing respirations, a breathing pattern which predisposes to development of airway and alveolar collapse. As ventilatory reserve decreases, risk of progressive atelectasis and secretion retention is increased. Prompt recognition of the signs and symptoms of this nursing diagnosis can prevent or reverse problems relating to ineffective airway clearance. Nursing management thus becomes the cornerstone of the individual's regimen of care.

Rehabilitation of the adult with head trauma

The changes incurred as a result of brain injury are often devastating. The approaches outlined in this article merely scratch the surface because the list of possible deficits is inexhaustible. The behavioral and cognitive capacity during the various phases of recovery dictate the intervention method that will be appropriate and successful, with concepts and tasks progressing from the simple to the more complex. When confusion, agitation, and inappropriate behavior are evident, safety is a prime concern. Some individuals do not progress beyond this stage. Placement and appropriate future planning are major issues in this situation. When behavior becomes more appropriate, inpatient rehabilitation efforts will be most beneficial and successful, with the focus on helping the individual regain functional skills. Improvement may be rather dramatic during this time, especially when compared with previous stages. Recovery beyond this point, with intact memory, goal-directed behavior, adequate socialization skills, and vocational rehabilitation, occurs over an extended period of time, perhaps years. With discharge, new concerns for the individual and family emerge as the reality of the situation becomes clearer. Health care providers in the community setting must recognize the effects of injury on the individual and the resulting psychosocial stresses and strains on the individual and family. Adequate neuromedical and neuropsychological follow-up are essential during the outpatient recovery phase to monitor progress and provide input for future plans.

Validating the nursing diagnosis of impaired physical mobility

The lack of research-based literature and of research models for validating nursing diagnoses results in some ambiguity in research efforts. Research must, however, move forward if there is to be progress in differentiating nursing and medical diagnostic models and use of nursing diagnoses to improve communication among nurses. Operational definitions of nursing diagnosis terminology are essential to continue work in validating nursing diagnoses, particularly in the clinical setting. The diagnosis impaired physical mobility was found to be an appropriate diagnosis for rehabilitation patients. Continued study and refinement of etiologies and defining characteristics is needed.

Alterations in movement: nursing assessment and implications

Physical assessment for nursing purposes is necessarily different from that of medicine because the focus of nursing is to diagnose and treat human responses to disease rather than the disease itself. This article will consider nursing assessment, pathophysiology, implications for daily living, and nursing implications for selected functional aspects of movement, namely seeing, eating, expressing (facially), speaking, moving, and walking.