Family caregivers' perspectives on hospice nursing care.

In hospice nursing, dying persons and their families are the unit of care and the focus of nursing interventions which are provided within the context of interdisciplinary care. The key component of hospice nursing is the interaction between the nurse, the terminally ill person, and the family. This naturalistic study was designed to describe the family caregiver's relationships between the hospice patient, the nurse, and themselves. The intent was to determine if family caregivers would develop empathic relationships with the hospice nurses. Nine bereaved family caregivers participated in the study. All were bereaved at least six months prior to being interviewed. The major finding of the study was that family caregivers perceived the hospice nurses as part of the family. The hospice nurses were characterized as respectful, kind, caring, clinical experts whose presence and interventions helped meet the needs of the family experiencing death.

Evaluating teaching effectiveness.

Major reform in nursing education is underway, with increased emphasis being placed on the importance of the teacher-student relationship. An instrument for evaluation of teaching effectiveness, developed at the Oregon Health Sciences University School of Nursing, attempts to capture the student's perception of the quality of the teacher-student relationship as well as other salient aspects of teaching practices. The evaluation tool contains 26 items evaluating teaching effectiveness and 14 items that evaluate the course. The teaching effectiveness items yield five scales including: knowledge and expertise, facilitative teaching methods, communication style, use of own experiences, and feedback. Psychometric testing has been completed and there is evidence of construct validity in relation to teaching effectiveness and internal consistency reliability for the five scales.

Establishing partnerships with family caregivers. Local and cosmopolitan knowledge.

Families now provide most of the care received by older people in the United States. Proposed changes in the health care system will mean that families must take an even greater role in delivering health care. It is crucial that nurses practicing in a variety of settings be prepared to establish partnerships with family caregivers in order to attend to the long-term care needs of older people.

The PREP system of nursing interventions: a pilot test with families caring for older members. Preparedness (PR), enrichment (E) and predictability (P).

The PREP system of nursing interventions, designed to increase preparedness (PR), enrichment (E), and predictability (P) in families providing care to older people, was pilot tested for acceptability and preliminary effectiveness. Eleven family units were assigned to the PREP group and 11 to a standard home health control group. The PREP group scored approximately one SD higher than the control group (p < .05) on the Care Effectiveness Scale, indicating greater preparedness, enrichment, and predictability. Further, on a rating of overall usefulness, the PREP group rated their assistance from PREP nurses (M = 9.75) as significantly higher (p < .01) than the control group rated assistance from the home health nurse or physical therapist (M = 6.57). Although not statistically significant, mean hospital costs for the PREP group ($2,775) were lower than for the control group ($6,929). Results provided support for a full intervention trial.

Establishing partnerships with family caregivers. Local and cosmopolitan knowledge.

1. The concepts of local and cosmopolitan knowledge may be used by gerontological nurses in creating partnerships with family caregivers to frail older people. 2. Local knowledge is the understanding and skills that the family brings to the caregiving situation; cosmopolitan knowledge is the understanding and skills that the gerontological nurse brings to the situation. 3. Four nursing interventions are guided by the conceptualization of local and cosmopolitan knowledge: acknowledging and affirming local knowledge when it is adequate; developing or enhancing local knowledge when it is inadequate; assisting family caregivers to apply local knowledge to problem solving; and blending local and cosmopolitan knowledge.

Family caregivers of post-hospitalized older persons and persons receiving hospice: similarities and differences.

The study reported here explored similarities and differences between 103 family caregivers of older persons who had been discharged from the hospital and 70 caregivers of terminally ill older persons receiving hospice care. Caregiving variables were selected for examination based on role theory. Major findings include: hospice caregivers provided significantly more personal care and medically related tasks, significantly fewer transportation tasks, and worried less than the post-hospitalized sample. Otherwise, the two groups were strikingly similar. Similar patterns of correlations for the two groups were also found.

Hospice care in Japan.

Hospice care was introduced in Japan in the 1970s. There are currently an estimated 21 programs, which are primarily hospital-based. This paper provides an overview of the history, current state, and future trends of hospice care in Japan. Four programs are described, including staffing information, length of stay, and prognoses of patients. Hospice care in Japan is compared to hospice care in the United States and major differences are described. Lastly, the concept of "truth telling" is explored within the context of the Japanese culture. The discussion is based on a review of the literature and a mailed survey completed by 16 Japanese hospice programs during July 1992. The paper is in four sections: An overview of Japan. The history, current state, and future trends of hospice care in Japan. The major differences between hospice care in Japan and the United States. An exploration of "truth telling" within the context of the Japanese culture.

Hospice research: the importance of program participation.

Hospice research is needed in order to understand the complex phenomena of holistic care for terminally ill persons and their families. Hospice program participation is key to future hospice research efforts. The purpose of this article is to encourage hospice programs to participate in hospice research. The discussion includes why research is done, who undertakes a research project, the role of institutional review boards in assuring rights of human subjects and potential strategies for recruitment of research subjects. The authors use their experiences with conducting hospice research to illustrate potential recruitment strategies.

Exploration of factors related to direct care and outcomes of caregiving. Caregivers of terminally ill older persons.

The purpose of this study was to explore factors related to the amount of direct care and outcomes of caregiving experienced by family members of terminally ill older persons using secondary analysis. A total of 55 caregivers whose care receivers were aged greater than or equal to 65 years were selected from Kirschling's (1988) hospice sample. The majority of caregivers were female (75%) and the spouse of the care receiver (66%). The duration of caregiving ranged from 1 to 180 months. Most care receivers were diagnosed with cancer (84%) and had been ill for 2-360 months (mean = 30.2). The mean length of time in hospice for care receivers was 2.4 months. Caregivers most frequently provided little extra tasks that were least difficult, least upsetting, and easier to provide. Behavioral problem tasks were least frequently provided but were reported as the most difficult, tiring, upsetting, and hardest to provide. Caregivers whose care receivers had been in hospice for greater than 34 days reported having to provide more communication tasks than caregivers whose ill older family members had been in hospice less than 34 days. Long-term caregivers (providing care for greater than 9 months) whose care receivers had been in hospice for greater than 34 days provided significantly fewer personal care tasks than short-term caregivers. Finally, there were no significant effects for duration of caregiving and length of time in hospice on outcomes of caregiving.

Oregon Hospice Association: statewide data set.

The Oregon Hospice Association (OHA) has developed a statewide data set on persons who die while receiving hospice services. The work to date is described, including the development and refinement of data collection forms, and selected results from 1989 and 1990. Although the data set is limited, the information generated does provide OHA staff and board members, and hospice programs in the state, baseline information to use with legislators, funding sources, and the media.

A conceptual framework for caring for families of hospice patients.

Hospice caregivers are usually family-focused in their practice with individual clients. Less often is the entire family as a unit considered the client. The authors present a conceptual framework for working with hospice families as clients. Their perspective incorporates concepts of the family as a system, the family life cycle, and the components of professional practice. Clinical examples illustrate the application of the framework in practice.

Social support: the experience of hospice family caregivers.

The concepts of social support, reciprocity, cost, and conflict were examined through a methodological study that assessed the reliability and validity of Tilden's (1986) Cost and Reciprocity Index (CRI). The CRI was modified for the face-to-face interviews with 70 family members who were caring for a terminally ill relative enrolled in a hospice program. Item analyses was undertaken with the four subscales because of qualitative comments, a desire to streamline administration of the measure and an overall drop in the alpha coefficients compared with those previously reported. Based on this work 25 items were retained in the four subscales, 13 were eliminated. Cronbach's alpha coefficients and the average inter-item correlation for the revised subscales are reported. Correlation analysis of the revised subscales was also undertaken in order to explore the relationship among the subscales and with time since the care receiver's diagnosis.

Measurement of spiritual well-being: a hospice caregiver sample.

This is a methodological study designed to assess the reliability and validity of Paloutzian and Ellison's (1982) Spiritual Well-being Scale. The scale was administered to 70 family members caring for a terminally ill relative. The 20 item measure yields three scores: spiritual well-being (overall score), existential well-being and religious well-being (overall score), existential well-being and religious well-being. The Cronbach's alpha coefficients were .95, .94, and .84 respectively. Construct validity of the measure is discussed in relation to Bradburn's Affect Balance Scale, qualitative data obtained during the interviews and a review of relevant literature related to spiritual well-being. Evidence in support of construct validity of the Spiritual Well-being Scale is lacking.

Assessing grief among the bereaved elderly: a review of existing measures.

The assessment of grief in the elderly, bereaved population has received much attention in the research and clinical literature. Existing instruments vary widely in their complexity, the extent of their theoretical base and in the evidence of their reliability and validity for their intended uses. In this article, the authors describe important principles for the assessment of grief, and present a rating instrument for use in comparing potential measures for this assessment. Nine of the most widely cited measures are reviewed using this process. Their variations along critical dimensions of assessment quality are clearly demonstrated. The general status of available measures, and recommendations for using this rating process in specific clinical settings are discussed.