Family caregiving in a pediatric renal transplant population.

Twenty parents (3 fathers and 17 mothers) engaged in caring for a child 2 to 14 months after renal transplant were studied to: (a) determine the kinds of caregiving tasks required and how difficult they are; and (b) explore the relationships among caregiver characteristics, caregiving burden, appraisal, and mood state. Increased housework, errands, providing emotional support, transportation, and monitoring/reporting symptoms were the most demanding tasks; housework, emotional support, and managing behavior problems were the most difficult. Overall, caregiving was perceived as moderately demanding and not particularly difficult, and the caregiving situation was not appraised as being very threatening. Mood dysfunction scores were quite low, but were associated with perceptions of caregiving difficulty. Caregiving demands and difficulty were greater with adolescent children, when the parent had other dependents to care for, and when the parent was working. This suggests the need for careful assessment of the family environment to identify parents at risk of caregiving burden.

Family caregiving in cases of hip fracture.

The growing incidence and cost and the serious nature of hip fracture in the elderly require a closer examination of the family's role in the rehabilitation process and how it can be assisted in that role. In this prospective study, 57 family caregivers provided information before the hospital discharge of the patient with hip fracture and at 2, 8, and 14 weeks postdischarge. They were asked about caregiving demands and problems, caregiver mood, expectations about recovery, and advice to future caregivers. A brief follow-up was conducted at 6 months. The care recipients were all women and had been living at home before injury. The postdischarge location of the patient (e.g., in a residence shared with the caregiver, in a different residence, or in a nursing home) was a major factor in the types of caregiving activities but not in total demand. Nonspouses cited the most problems. Mood distress did not change over time. Caregivers appeared to have unrealistic expectations about the length of the recovery period; by 14 weeks, 35% judged the care recipient's mobility to be worse than expected, and 20% felt that the patient had more pain than expected. The most frequent advice to future caregivers was to have patience and to give encouragement.

Posthospital convalescence in older women with hip fracture.

Women who had lived at home before hip fracture repair (N = 120, M age = 79.9) were interviewed before hospital discharge and at 2, 8, and 14 weeks postdischarge to determine (a) early recovery patterns in function and mood, (b) factors predictive of assistance needed in mobility and perceived mobility compared to prefracture status, (c) problems faced, and (d) advice to others. The mobility pattern was that of a relatively rapid gain until 8 weeks, with a smaller gain from 8 to 14 weeks. Affective mood distress was low except in those going to nursing homes. Somatic mood distress was high, decreasing only gradually. Factors predictive of needed assistance in mobility and of perceived mobility included both those without potential for nursing intervention (age, prefracture mobility, how fell, and type of surgical procedure), and those with the potential for intervention (affective distress, fatigue, and urinary problems). Persistent problems related to limitations in mobility, especially in dressing. Overwhelmingly, subjects advised the need for maintaining a good mental attitude.

Early outcomes after hip fracture among women discharged home and to nursing homes.

In a prospective design, early outcomes after hip fracture were compared in three groups of formerly community-living women: those discharged home from the hospital (n = 58), those discharged to a nursing home (NH) and staying there < or = 1 month (n = 23), and those staying > 1 month (n = 39). Data were collected on mobility and mood states prior to hospital discharge and at 2, 8, and 14 weeks. Overall recovery ratings were obtained at the latter three times; readiness for discharge from hospital and nursing home also was examined. The short-stay group did as well in regaining mobility as the home-discharge group and both rated their overall recovery similarly. Affective mood distress was associated with discharge destination site. The short-stay NH group had a greater proportionate lack of designated caregivers than either of the other two groups. Research is needed to identify features of nursing homes as well as characteristics of patients that contribute to positive outcomes in the large number of hip fracture patients currently discharged to these institutions.

Appraisal of illness, symptom distress, self-care burden, and mood states in patients receiving chemotherapy for initial and recurrent cancer.

Cancer recurrence may present unique stressors for patients receiving chemotherapy. The objectives of this exploratory study were to (1) describe perceptions of symptom distress, self-care burden, appraisal of illness, and mood in patients undergoing chemotherapy, (2) identify differences in these perceptions according to stage of illness (new versus recurrent cancer), and (3) test a theoretical model of the mediating effects of appraisal. Subjects completed a modified Symptom Distress Scale, the Self-Care Burden Scale, the Family Hardiness Index, the Appraisal of Illness Scale, the short form of the Profile of Mood States, and a self-report form that included personal and illness characteristics and questions about the subjects' current situation. The 60 subjects were outpatients being treated for initial cancer (n = 28) or recurrent cancer (n = 32). Those with recurrence had higher symptom distress and health deviation self-care burden scores and more stressful appraisals; mood scores were low and did not differ between groups. Appraisal, symptom distress, and perceived seriousness predicted 36% of variance in affective mood, with appraisal partially mediating the effects of symptom distress. Somatic mood (36%) was best predicted by symptom distress and universal self-care burden (USCB). Economic status, symptom distress, and recurrence status predicted 49% of appraisal variance. Symptom distress was predicted best by recurrence and symptom control; USCB was predicted best by economic status and perceived dependency. Results suggest the need for different nursing interventions for the two groups. Further model testing is recommended.

Relocation appraisal, functional independence, morale, and health of nursing home residents.

Relocation to a nursing home can be stressful and may result in mental and physical illness. Appraisal, or the meaning assigned to relocation, can influence relocation outcome. This study examined the relationships between appraisal of relocation and 30 nursing home residents' psychological and physical health, morale, functional independence, and demographic and situational factors, including age, gender, income, education, prior residence, participation in the decision to relocate, and preparation for the move. Positive, benign, and challenge appraisals were related to higher morale and functional independence. Threat appraisal was related to poorer psychological health and lower morale. Harm-loss appraisal was associated with lower morale and lower functional independence. Preparation for the move was related to higher positive appraisal, higher morale, functional independence, and lower harm-loss scores. Implications include the need to assess people's appraisal of relocation so as to plan strategies that prevent relocation stress.