Family Caregiving of Patients With Heart Failure and Vascular Dementia in Rural Appalachia: A Mixed-Methods Study.

INTRODUCTION: Vascular dementia and heart failure (HF) are common co-existing conditions among adult populations. Each condition requires extensive home caregiving from family caregivers, especially those in rural Appalachia. This study aimed to assess caregivers' burden and their physical and mental health status, as well as explore their experiences and needs. METHODS: This study used an exploratory mixed-methods design combining quantitative and qualitative research (N = 20 caregivers). We collected data using questionnaires, short-answered interviews, and focus group discussions. The multivariable generalized linear model (GLiM) was used to analyze quantitative data; content analysis was used for qualitative data. RESULTS: The average age of family caregivers was 64.95 years. The generalized linear model showed that the caregiving burden was associated with caregivers' depression/anxiety (r = 0.68, P < .001) and their number of dementia caregiving years (r = 0.54, P < .05). Caregivers' poor physical health status was associated with better preparedness for HF and dementia home caregiving (r = 0.52, P < .05) and male caregivers (r = -0.46, P < .01). Caregivers' mental health status was associated with depression/anxiety (r = -0.80, P < .001). The qualitative data identified key caregiving themes: emotional impact and physical demands of caregiving, lack of help in rural areas, dealing with multiple disease progression, and relationship changes with their loved ones. CONCLUSION: Caregiving burden was associated with caregivers' home care responsibilities and the need for support. Nurse-led home caregiving preparedness interventions tailored for family caregivers of patients with HF and dementia in rural areas are recommended.

A social network analysis to explore collaborative practice in home care: research protocol.

BACKGROUND: The conceptualization of the home as a care environment and maintaining a high standard of care requires different professionals to collaborate. This study will explore collaborative practice in home care, needs and expectations of the stakeholders involved, and identify their roles and tasks. Secondly, it will investigate possible strategies to improve home care management and, more particularly, optimize collaborative practice in home care. METHODS: The study will be conducted during three distinct consecutive phases, within a multiphase mixed-methods design. Phase 1 will use a quantitative approach in which a social network analysis will be conducted to have an overview of collaborative practice in home care in French-speaking Switzerland. Phases 2 and 3 will be qualitative and focus on three different situations involving different locations (rural and urban) and different home care functioning (home care provided by agencies and home care providing by independent caregivers). In each situation, semi-structured interviews will be conducted with home care recipients and their home caregivers. In phase 2, results of phase 1's network analysis will be discussed, such as roles, needs, and expectations of all stakeholders involved in home care. In phase 3, phase 2's findings will be discussed and strategies to improve home care and to optimize collaborative practice will be explored. DISCUSSION: Over the past years, home care has grown considerably. Therefore, more and more different caregivers are involved in the recipients' homes. Since optimal coordination between these different caregivers is a prerequisite for quality and safe care, it is essential to investigate the existing collaborative practice and how it is functioning. This study will provide knowledge on roles, needs and expectations of different caregivers involved in home care. It will also allow for strategies to optimize collaborative practice and thus ensure comprehensive care for recipients. Finally, it will serve as a basis for future studies that can be conducted to address identified needs.

Caregiver´s perception of the home-based management of childhood malaria in Baneghang and Fombap health areas in the West Region of Cameroon.

Introduction: adequate community perception of malaria is crucial to improving prevention, diagnosis, and treatment. This study aimed to determine the caregiver´s perception of the home-based management of childhood malaria in Baneghang and Fombap health areas, Cameroon. Methods: a cross-sectional study was carried out to assess the knowledge, attitudes, and practices of home caregivers (HCGs) in Baneghang, a health area under Community Directed Intervention (CDI), and Fombap, a CDI-free health area. Community health workers (CHWs) conducted a census to identify households with under-five children that constituted a sample frame, and then a systematic random sampling was used to select HCGs. Analysis of variance was used to compare the mean score perceptions of HCGs in the management of childhood malaria at the two sites. Results: out of 420 HCGs interviewed, 161 (38.3%), 226 (53.8%), and 271 (64.5%) displayed correct knowledge, positive attitude, and good practice, respectively, towards childhood malaria prevention, diagnosis, and treatment in both study sites. The mean score knowledge of HCGs in Baneghang was significantly higher than that of those in Fombap (7.33 versus 6.94, p < 0.001). The mean score of attitudes of HCGs towards childhood malaria was also higher in Baneghang than in Fombap (6.59 versus 6.29, p=0.013). However, the mean scores of good practices of HCGs on childhood malaria in both health areas were similar (5.94 versus 5.92, p=0.921). Conclusion: home-based management of childhood malaria seems to have contributed to good knowledge and positive attitudes of HCGs on malaria prevention, diagnosis, and treatment.

Association between work content and musculoskeletal disorders among home caregivers: a cross-section study.

In Taiwan, over 80% of home caregivers have experienced musculoskeletal disorders (MSD) in the past year. Although MSDs in health care workers have been discussed in existing literature (e.g., in nursing staff), there is limited understanding of the association between MSD and the work content of home caregivers. This study aimed to investigate the correlation between the work content and MSD of home caregivers. This cross-sectional study was conducted in long-term care units in central Taiwan. A structured questionnaire was used to collect data, including basic information, work content survey, and information from the Nordic Musculoskeletal Questionnaire. Logistic regression analysis was used to examine the association between work content and MSD. A total of 149 home caregivers with a mean age of approximately 50.97 ± 9.80 years were recruited for the study. The frequency of transfer of toilet and wheelchair was significantly associated with shoulder discomfort, upper back discomfort, and wrists/hands discomfort. In addition, the frequency of passive range of motion exercise was significantly associated with elbows discomfort. The results of this study indicated that the highest risk factor for MSD was transfer of toilet and wheelchair followed by passive range of motion exercise.

A qualitative study on the experience and feeling of home care aides who take part in nighttime caring / 中国实用护理杂志

Objective:To explore the experience and true feeling of home care aides during nighttime caring at the first beginning stage of this program, find the difficulty of it and provide constructive suggestions for improvement.Methods:Semi-structed interviews were used to collect the data of 16 home care aides who were taking part in nighttime caring. Colaizzi phenomenological analysis was used to process and analyze the data.Results:Three themes were extracted by classifying and analyzing the details of the interview: the service content of nighttime care was easy, but had many constraint conditions; the caregivers had diversified emotional experience during nighttime care; the elderly would like to enjoy nighttime care, but they were unwilling to pay by themselves.Conclusions:Nighttime caring project deepens the service content of home-based care. But the nighttime care project needs to be standardized. We should establish risk prevention measures to guarantee the benefit and security of both home caregivers and care-receivers, changing the opinions of consumption among the elderly, increasing the amount of subsidy to enlarge the expansion of nighttime care and improve the equality of this caring program.

Home-Based Intervention for the Prevention and Treatment of Malaria Among Children Younger Than 5 Years in the West Region of Cameroon: Protocol for a Randomized Controlled Trial.

BACKGROUND: Although malaria is preventable and curable, 1 child dies of this disease every 2 minutes in Africa. Home-based management of malaria reduces the progression of severe malaria by more than 50%. Scalable, efficacious, and cost-effective strategies are needed to empower the capacities of home caregivers of children younger than 5 years of age in health education, diagnosis, and treatment of malaria at home. OBJECTIVE: The main objective of this trial is to assess the impact of the management provided by home caregivers on the prevention, diagnosis, and treatment of malaria in children younger than 5 years as compared to the home-based malaria management component of the integrated community-directed intervention (CDI) strategy of community health workers (CHWs). METHODS: A randomized controlled trial will be conducted. CHWs have conducted a census of all households where there is at least one child younger than 5 years with their home caregivers. These children and their home caregivers have been randomly placed into the intervention or control groups among the households identified. The trial will allow malaria home-based prevention, diagnosis, and treatment of 350 children younger than 5 years old by home caregivers in the Fombap area (intervention group) where the integrated CDI strategy will not implemented. This group will be compared to the home-based malaria management component of the integrated CDI strategy in which 350 children in the same age group will be followed up by CHWs in the Baneghang area (control group). The primary outcomes will be the prevention, diagnosis, and treatment of malaria in children younger than 5 years of age by home caregivers at home. The secondary outcomes comprise the malaria follow-up indicators produced by home caregivers in the intervention group and those produced by CHWs in the control group. Both descriptive and one-way analysis of variance estimation techniques will be used to compare the mean difference in the 2 strategies. RESULTS: From September 2019 to October 2019, all home caregivers with children younger than 5 years of age were identified in the intervention and control group by CHWs. Following this, 203 home caregivers with their 350 children younger than 5 years were randomly selected and enrolled in the intervention group, while 225 home caregivers with their 350 children younger than 5 years were enrolled in the control group. In the intervention group, 203 home caregivers were trained in November 2019. This home treatment effectively started in December 2019 and will continue until May 2020. CONCLUSIONS: Findings from this randomized controlled trial will contribute to resolving the challenges of severe malaria and to limiting the death due to malaria of children younger than 5 years. This will bring benefits to home caregivers who will know how to promptly diagnose and properly treat malaria in their children at home. TRIAL REGISTRATION: Pan African Clinical Trial Registry (PACTR) 202003487018009; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9788. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/19633.

Exploring Pictorial Health Education Tools for Long-Term Home Care: A Qualitative Perspective.

Regarding long-term home care needs, nurses need to communicate effectively and reasonably when teaching home caregivers. Designers can assist medical staff and develop pictorial tools to enhance communication. The purpose of this study is to explore a theoretical basis from the perspective of designers, patients' home caregivers, and medical staff to construct a theoretical framework that can jointly develop pictorial health education tools and healthcare system. The qualitative methods, including in-depth interview and observation, are applied to this study; ground theory sets out to construct a framework from the verbatim transcript of the interviews. Based on interview results, six axial codes were extracted: (1) the method of interdisciplinary cooperation; (2) medical research ethics; (3) communication methods; (4) forms of health education tools; (5) development of health education tools; (6) home care intubation procedure. Eight groups of home caregivers offered suggestions from their experiences. The designers need to assist medical staff to solve real problems, pay attention to professional norms, and forms of cooperation. Health education tools need to meet the needs of medical staff and home caregivers and designers should pay attention to the processes of communication. This study can also assist in interdisciplinary cooperation to explore the theoretical basis of pictorial health education tools for nurses in the context of long-term care at home.

Broadening the scope of live-in migrant care research: How care networks shape the experience of precarious work.

Live-in migrant care work is increasing across welfare states. In the context of ageing populations and changing healthcare systems, live-in care enables ageing in place without overburdening family caregivers. However, research has shown that live-in care often puts migrant care workers and their recipients in precarious positions. While the outcome of precarious work has gained attention, it is not self-evident. Based on interviews with migrant care workers in the Netherlands, as well as formal and informal caregivers, and the staff of intermediary organisations, this study shows that besides client conditions, the interactions of actors in the care network shape the circumstances and experience of migrant live-in care work. The findings suggest that managing the care networks to which migrant care workers belong makes it possible to mitigate the associated precariousness.

Development and Evaluation of an Online Training System for Home Caregivers.

With the increasing demands of professional rehabilitation training for home caregivers, to develop a mode of training with widespread applicability has been emphasized. In order to improve life quality of the impaired elderly, we developed an online training system for the home caregivers to learn knowledge and skills for caring the elderly. We also assessed the acceptance and acceptance factors of the online training system. The results showed that our training system was well accepted by the participants. The perceived usefulness and perceived ease of use were the dominant factors influencing the acceptance of the online course. Therefore, quality management and easy to use, rapid to capture the system are essential for the users to accept the training courses or health information better. An online training system with professional and standard protocols may be popular and well accepted for home caregivers.

Satisfaction and difficulties of French professional home caregivers in supporting older people with Alzheimer's disease or alcohol misuse.

In France, few studies have examined home care when it comes to ageing support and even fewer have considered alcohol misuse in this context. The studies also show that being old and having alcohol use disorders are two unfavourable conditions for receiving help, whereas for the Alzheimer's disease, there is a clear need for optimal care. In this article, we study professional home caregiver's perceptions of their job along with their difficulties and satisfactions in supporting older people with Alzheimer's disease or alcohol misuse. Out of the 23 professionals approached, 17 took part in a research interview from October 2013 to January 2014. All interviews were recorded, fully transcribed and lexically analysed with Alceste® software. Among the five classes that were identified from 63% of the initial data, the main themes that emerged illustrate the nature of the associated pathologies, the perceptions and satisfactions related to the profession, their adaptive skills, the difficulties related to the life context of the older person, and the wine consumption of the latter. The lexical discourse analysis shows that the professional home caregivers are involved in looking after not only people with Alzheimer's disease but also those with alcohol misuse. However, despite the difficulties and satisfactions encountered, adaptation to the older people seems to be their priority and one of the many skills that they have acquired during their professionalisation. Most of the older people who are helped are women and the difficulties mentioned by their caregivers usually arise at the time of their death. Lastly, when caring for alcohol misusers, they describe negative attitudes in their support. Although research in this area is rare while home care for the older person, whatever the pathology, is increasing, professionals need to be supported by the associations or companies that employ them and should be trained to help them provide the appropriate care.

The perspective of employers/families and care recipients of migrant live-in caregivers: a scoping review.

In high-income countries, migrant live-in caregivers are increasingly in demand to provide health and social care in the home. While there is a wide range of research on the perspectives of live-in caregivers (including domestic workers) in destination countries, few studies address the perspective of families who hire them. The aim of this study was to explore the extent, range and nature of international literature on the needs and experiences of employers/families and care recipients of live-in caregivers. We undertook a scoping review of the literature on this topic using Arksey and O'Malley's five stages. With the assistance of a health science librarian, a comprehensive search of nine databases was undertaken from April to July 2014. Two research assistants independently reviewed 2493 articles. The data were analysed through data charting, numerical summary and thematic analysis. Thirteen articles met the inclusion criteria for the scoping review. Many of these studies (n = 7) were conducted in Israel, and the majority (n = 8) focus on elderly care recipients. The findings reveal the diverse roles live-in caregivers perform, including emotional and physical care; changes in family dynamics and roles upon hiring a live-in caregiver; the negative experiences, including abuse, of live-in caregivers and elderly care recipients; the positive outcomes for families with a live-in caregiver; and families' common perception that live-in caregivers are like kin, a part of the family. Furthermore, evidence points to some degree of bi-directional emotional support between caregivers and employers/families, which adds complexity to their relations and the negotiation of power.

Caregivers' representations of elders who drink too much alcohol: crossroads between professional home caregivers and hospitals nurses.

Being old or having alcohol use disorders are two unfavorable conditions for receiving help or optimal care. When these two conditions are associated, professionals are even less attracted to work with old alcoholics. To address this issue, from the professionnals perspective, two studies based on research interviews were crossed, one was conducted with 17 professional home caregivers and the other with 29 hospital nurses. A double analysis of the collected speech was manually performed, then computerized by the Alceste® software. This qualitative research, may have indirectly selected the most favorable agents concerned by the issue: those who agreed to answer. Professional home caregivers have negative and demeaning representations of older drinkers (manipulative, nasty, violent...), which generate feelings of powerlessness when faced with them and deleterious identifications. Despite an expressed lack of training and a lack of support for their activities, these agents are able to develop skills in their caregiving interventions, and find professional satisfaction by accompanying them. Nurses also have an initial negative impression of elders misusing alcohol, but these professionals rapidly consider them as less violent and more approachable than younger adults with alcohol use disorder. The exchanges with these old alcoholic patients, often resort to humor, in a possible attempt for proximity, while the same agents report only very few skills to care for elderly alcoholics. Despite all these negative precedents, care is possible and develops itself in daily practice. Beyond initial and spontaneous adverse reactions, while they feel very isolated and little supported in their actions, professional home caregivers as well as nurses, develop daily assistance and care with elders misusing alcohol. The professional home caregivers' expectancy for training and the nurses' expectancy for support could help improve the first approach of these elders and the quality of care offered to them.

Viral respiratory infections in a nursing home: a six-month prospective study.

BACKGROUND: The knowledge on viral respiratory infections in nursing home (NH) residents and their caregivers is limited. The purpose of the present study was to assess and compare the incidence of acute respiratory infections (ARI) in nursing home (NH) residents and staff, to identify viruses involved in ARI and to correlate viral etiology with clinical manifestations of ARI. METHODS: The prospective surveillance study was accomplished in a medium-sized NH in Slovenia (central Europe). Ninety NH residents and 42 NH staff were included. Nasopharyngeal swabs were collected from all participants at enrollment (December 5th, 2011) and at the end of the study (May 31st, 2012), and from each participant that developed ARI within this timeframe. Molecular detection of 15 respiratory viruses in nasopharyngeal swab samples was performed. RESULTS: The weekly incidence rate of ARI in NH residents and NH staff correlated; however, it was higher in staff members than in residents (5.9 versus 3.8/1,000 person-days, P = 0.03), and was 2.5 (95 % CI: 1.36-4.72) times greater in residents without dementia than in residents with dementia. Staff members typically presented with upper respiratory tract involvement, whereas in residents lower respiratory tract infections predominated. Respiratory viruses were detected in 55/100 ARI episodes. In residents, influenza A virus, respiratory syncytial virus, and human metapneumovirus were detected most commonly, whereas in NH staff rhinovirus and influenza A virus prevailed. 38/100 ARI episodes (30/56 in residents, 8/44 in staff) belonged to one of three outbreaks (caused by human metapneumovirus, influenza A virus and respiratory syncytial virus, respectively). NH residents had higher chances for virus positivity within outbreak than HN staff (OR = 7.4, 95 % CI: 1.73-31.48, P < 0.01). CONCLUSIONS: ARI are common among NH residents and staff, and viruses were detected in a majority of the episodes of ARI. Many ARI episodes among NH residents were outbreak cases and could be considered preventable. TRIAL REGISTRATION: The study was registered on the 1th of December 2011 at ClinicalTrials ( NCT01486160 ).

[Not Available]. / Les aidantes professionnelles à domicile dans l'accompagnement de personnes âgées atteintes de la maladie d'Alzheimer ou présentant des conduites d'alcoolisation : évaluation qualitative et réflexions cliniques.

In France, few studies have investigated the experience of home caregivers with elderly people suffering from Alzheimer's disease or alcoholic behavior. The aim of this study was to describe caregivers' understanding of these disorders to identify their difficulties and satisfactions in relation to their role. Seventeen social care workers were interviewed and the content was analysed using a general inductive approach. Regarding misuse or abuse of alcohol, they expressed a feeling of helplessness, and put forth their experience and skills to communicate with the receiver of care. Concerning Alzheimer's disease, they expressed worries regarding its progression They identified themselves with the elder's anxiety, which induced fears regarding their own old age. All of them were satisfied by the care they provided and by the possibility of acquiring experience. Results could be of use in supporting clinical preventive actions for professional home caregivers dealing with these two disorders that can occur in the course of the ageing process.

Migrant Nurses and Federal Caregiver Programs in Canada: Migration and Health Human Resources Paradox.

Despite the links between health human resources policy, immigration policy, and education policy, silos persist in the policy-making process that complicate the professional integration of internationally educated nurses in Canada. Drawing on the literature on nurse migration to Canada through the Live-in Caregiver Program, this paper sheds light on the contradictions between immigration and health human resources policy and their effect on the integration of internationally educated nurses in Canada. The analysis reveals a series of paradoxes within and across immigration and health human resources policy that affect the process of professional integration of this group of health professionals into the nursing workforce in Canada. I will further link the discussion to the recently implemented Caregiver Program, which provides a unique pathway for healthcare workers, including nurses, to migrate to Canada. Given recent introduction of the Canadian Caregiver Program, major policy implications include the need to bridge the gap between health human resources policy and immigration policy to ensure the maximum integration of migrant nurses in Canada.

[Psychological effects of alcohol misuse on the professional home caregivers in support with elderly people]. / Les effets psychologiques des conduites d'alcoolisation des âgés sur le vécu de la relation d'aide des professionnelles du domicile.

Very little research is made on professional home caregivers in support of seniors, especially those dealing with alcohol misuse. The aim of this study was to investigate the relationships between professional home caregivers and seniors with alcohol misuse, in terms of job satisfaction, professional life and emotional exhaustion. 99 professional home caregivers completed a professional data questionnaire (ESVP) and an inventory of professional burnout (MBI). Demographic and professional data, as well as dimensions of professional life satisfaction and professional exhaustion questionnaires were analyzed. Out of the 99 participants, 36 professional home caregivers reported difficulties dealing with alcohol misuse in seniors. The mean age of the home caregivers was 35 years old and half of them did not receive any training for support. The majority of them qualified the relationship with the aged as "distant and nonexistent". In contrast, most of them were satisfied with regard to the relationship with the relatives of the subjects, and were almost as many to call it "cordial" as well as "cold distant, non-existent". Job satisfaction was positively correlated with the satisfaction of the relationship with the relatives. Emotional exhaustion was negatively correlated with their job satisfaction in the support of the subjects. This study is, to our knowledge, the first one to highlight the importance for professional home caregivers to have good relationships with the relatives of seniors with alcohol misuse. Research in this area is scarce, despite the development of home care for the elderly, whatever their pathologies, and at the early start of a French ministerial plan on society's adaptation to ageing.