Validación de la versión castellana de la Finding Meaning Through Caregiving Scale© (Farran et al., 1999) / No disponible

No disponible

Finding meaning through caregiving: development of an instrument for family caregivers of persons with Alzheimer's disease.

Systematic assessment of the positive aspects of caregiving has been limited by the lack of comprehensive, theoretically based, and psychometrically sound measures. This study developed and tested a measure primarily designed to assess positive aspects and ways that caregivers find meaning through their experience of caring for a person with dementia. The measure has three subscales: Loss/Powerlessness, which identifies difficult aspects of caregiving; Provisional Meaning, which identifies how caregivers find day-to-day meaning; and Ultimate Meaning, which identifies philosophical/religious/spiritual attributions associated with the experience of caregiving. The measure is useful for understanding the close relationship between both the difficult and positive aspects of caregiving and also may be used to identify a caregiver's strengths in clinical and research settings.

Managing cognitive impairment in the elderly: conceptual, intervention and methodological issues.

PURPOSE: With the aging of society, the incidence of dementia in the elderly is also increasing, and thus results in increased numbers of individuals with cognitive impairment. Nurses and other researchers have investigated issues concerning the management of cognitive impairment. This article highlights conceptual, intervention and methodological issues associated with this phenomenon. CONCLUSIONS: Cognitive change is a multivariate construct that includes alterations in a variety of information processing mechanisms such as problem solving ability, memory, perception, attention and learning, and judgement. Although there is a large body of research, conceptual, intervention and methodological issues remain. Much of the clinical research on cognitive impairment is atheoretical, with this issue only recently being addressed. While many clinical interventions have been proposed, few have been adequately tested. There are also various methodological concerns, such as small sample sizes and limited statistical power; study design issues (experimental vs. non-experimental), and internal and external validity problems. Clearly, additional research designed to intervene with these difficult behaviors is needed. IMPLICATIONS: A variety of psychosocial, environmental and physical parameters must be considered in the nursing care of persons with cognitive impairment. Special attention has been given to interventions associated with disruptive behaviors. Interventions are complex and knowledge must be integrated from both the biomedical and behavioral sciences in order to deal effectively with the numerous problems that can arise over a long and changing clinical course. Some researchers and clinicians have suggested that a new culture regarding dementia care is needed, one that focuses on changing attitudes and beliefs about persons with dementia and one that changes how organizations deliver that care. This review identifies key conceptual, intervention and methodological issues and recommends how these issues might be addressed in the future.

Quantifying psychosocial nursing interventions provided to geropsychiatric inpatients.

The purpose of this pilot study was to develop and test the Geropsychiatric Intervention Checklist (GPIC), a measure designed to quantify psychosocial nursing interventions provided to persons on a geropsychiatric inpatient unit (N = 48). Data were collected by nursing staff, using self-report methods. This pilot study lays the foundation for future research designed to examine the impact of nursing interventions on geropsychiatric inpatient outcomes.

Psychiatric home care of elderly persons with depression: unmet caregiver needs.

The purpose of this study was to explore what nursing interventions are currently being provided to family caregivers of elderly persons with depression as a part of standard home health care; and identify unmet needs of these family caregivers. Unmet caregiver needs were examined from both the family caregiver and staff nurse perspective, using caregiver structured interviews and staff focus groups. Ten caregivers participated in structured interviews and nine staff nurses participated in three focus groups. Caregivers reported unmet needs concerning support and respite, dealing with their own feelings, learning more about care-related tasks and role changes, and stress management. Similarly, nurses speculated that nursing interventions should focus on increased counseling, family and community support, assisting caregivers with their learning needs and care-related responsibilities. These findings contribute toward a better understanding of interventions currently provided to caregivers of depressed elderly persons, as a part of standard psychiatric home care; identify unmet caregiver needs; and suggest areas for future psychiatric research in home care settings.

Wives, husbands, and daughters of dementia patients: predictors of caregivers' mental and physical health.

The purpose of this study was to investigate differences in and predictors of mental and physical health among wife, husband, and daughter caregivers of dementia patients using a stress and coping framework. The sample of 151 caregivers consisted of 55 wives, 43 husbands, and 53 daughters and was recruited from multiple community-based sources. Variables addressed were caregiver age, social position, years spent in caregiving, dementia severity, burden, worry, physical health, and mental health. Analysis of variance demonstrated gender-specific, kinship group differences in burden (F = 8.09, p = .000), worry (F = 6.287, p = .002), and age (F = 55.27, p = .000). Post hoc comparisons indicated that wives reported worrying most, while husbands were oldest and reported the least burden. Health predictors differed by group, with wives' mental health being predicted by severity of dementia, age, and worry (R2 = .16), husbands' mental health was predicted by burden and worry (R2 = .18); and worry was the only significant predictor of daughters' mental health (R2 = .33). Wives' physical health was predicted by years of caregiving and age (R2 = .10); husbands' physical health was predicted by age and worry (R2 = .24); and daughters' physical health was predicted by years spent in caregiving and burden (R2 = .27). Findings suggest that a stress and coping framework is a better predictive model for daughters' mental and physical health than for health of wives and husbands. Findings further indicate that different health-related nursing interventions may be required for different caregiver groups.

Race, finding meaning, and caregiver distress.

This study investigated the relationship between race, finding meaning (as a positive psychological resource variable), and the outcomes of caregiver depression and global role strain among 77 African American and 138 White spouse caregivers of persons with dementia. Finding provisional meaning had a direct negative relationship with depression and global role strain. Although African American caregivers were less likely to report depression and role strain, there was no interaction by race in the process influencing caregiver distress.

Theoretical perspectives concerning positive aspects of caring for elderly persons with dementia: stress/adaptation and existentialism.

Research concerning caregivers of persons with dementia has predominantly been guided by a stress/adaptation paradigm. This paradigm, however, does not fully address the issue of how caregivers manage to do so well under difficult circumstances. Existentialism offers an alternate theoretical view for exploring this issue. This article compares and contrasts these two paradigms-their key elements, strengths, and limitations, and areas of convergence and divergence. It identifies implications for future theory development, research, and clinical practice.

A continuum of care in Alzheimer's disease.

This article describes the care and service needs of persons with Alzheimer's disease. In particular, it discusses the advanced nurse practitioner's clinical, educational, and research roles in maintaining the health of these individuals with cognitive impairments over the disease trajectory. Four stages of the disease are identified: early, middle, late, and terminal. Patient symptoms, family caregiver needs, and the role of the advanced nurse practitioner during each stage are articulated.

Who are these patients and what services do they receive?

The purpose of this study was to develop baseline information concerning older adults who use psychiatric home healthcare services, identify critical components of interventions provided over the course of treatment, and identify outcomes associated with this type of home care. This review focused on patients 65 years or older with Medicare coverage and a primary or secondary diagnosis of depression. Retrospectively, 107 charts were reviewed, beginning with those of patients most recently discharged. These psychiatric home care patients had complex healthcare problems, required family caregivers and multiple home healthcare services, and experienced variable outcomes. These findings support the need for more information regarding specific interventions provided to patients and their family caregivers and what effect these interventions have on patient and caregiver outcomes.

Psychiatric home care for the elderly.

This study summarizes descriptive information concerning an existing psychiatric home care service and lays the foundation for more sophisticated studies of elderly depressed persons who receive this type of long term care. Using existing medical record data, the demographic and clinical characteristics of the elderly patients using a multi-site home health care service are summarized, including: (1) their functional/psychiatric status, (2) their length of stay, (3) caregiver availability, (4) scope of multidisciplinary interventions provided, and (5) reasons for discharge. Prospective research of elderly persons receiving psychiatric home care is needed in the future.

Race, control, mastery, and caregiver distress.

This study investigated the relationship between race, psychological resources of sense of control and caregiver mastery, and distress outcomes of caregiver depression and role stain among 77 African American and 138 White spouse caregivers of persons with dementia. Patterns of association between psychological resources and caregiving distress outcomes varied by type of outcome. Sense of control had a direct negative relationship with depression. Caregiver mastery moderated the effects of stressors on depression and was the only significant psychological resource predicting role strain. Although African American caregivers were less likely to report caregiver depression and role strain, there were no race differences in the process influencing caregiver distress.

Interventions for caregivers of persons with dementia: educational support groups and Alzheimer's association support groups.

This study compared three groups of dementia caregivers: educational support group (ESG) participants, Alzheimer's Association support group (AASG) participants, and a contrast group (CNG) of nonparticipants. ESG members reported lowest levels of care-receiver impairment. AASG members more frequently were wives, reported highest levels of care-receiver impairment, and expressed highest levels of concerns for themselves. CNG members reported lowest levels of concern for both themselves and their care receiver. As a means of further understanding why caregivers might have selected the ESG or the AASG, underlying group leader, group member, and group process characteristics were examined.

Dementia care-receiver needs and their impact on caregivers.

This study examines home-based persons with dementia, their needs associated with activities of daily living (ADL), cognitive impairment, and disruptive behaviors, and the relationship of these needs to caregiver distress and burden. Findings suggest that selected disruptive behaviors were most distressing to caregivers, and that when disruptive behaviors occurred more frequently, caregivers were significantly more distressed with these behaviors and reported higher levels of burden. The frequency of cognitive impairment behaviors and level of ADL impairment were not significantly related to caregiver burden, but caregiver distress with these needs was significantly related to caregiver burden.

Research considerations. Geropsychiatry unit evaluation.

The specialized psychiatric units for geriatric patients are believed to be effective, yet no studies could be found documenting this. A method of evaluating the effectiveness of a geropsychiatric program is to measure changes in the cognitive and functional status of its patients. This study supports the hypothesis that there would be an improvement in the geropsychiatric patients' cognitive and functional assessment scores by discharge and after hospitalization.

Chronic dyspnea and suicide in elderly men.

In a structured psychological autopsy study of suicide in older adults, 14 cases in which the subjects experienced chronic dyspnea in the months or weeks before death were examined. Thirteen of the subjects were white men. Most had a diagnosable psychiatric disorder, although none had previous contact with a mental health professional. Other common characteristics were chronic or terminal heart or lung disease, very recent contact with a primary physician, prior experience of self or a significant other suffering a debilitating disease, and a fiercely independent and inflexible personality type. The cases illustrate the intricacy of risk factors associated with suicide and alert other investigators and health care professionals to a possible link between chronic dyspnea and suicide risk.

Clinical assessment of hope.

In recent years, nurse researchers have given more attention to the role that hope plays in health and illness. While this research adds to the knowledge base about hope, that this knowledge may become too theoretical and difficult to apply in the clinical setting. Based on a study of hope conducted with community-based older adults, an analysis of the hope instruments used in this study, and ongoing clinical experiences, a guide for the clinical assessment of hope is proposed.

Finding meaning: an alternative paradigm for Alzheimer's disease family caregivers.

Theoretical formulations of stress and coping, family systems, crisis intervention, and loss and grief have inadequately explained how persons might grow and find meaning through their caregiving experiences. An existential theoretical framework guided the data interpretation in a qualitative study of 94 dementia family caregivers. Results suggest that an existential framework provides an alternative paradigm for understanding the caregiving experience.