Transiting Back Home: Caregivers' Lived Experiences in Caring for Loved Ones on the Nasogastric Tube in the Home-Setting in Singapore.

INTRODUCTION: Little is understood about caregivers' lived experiences when first caring for patients on the nasogastric tube at home in an Asian setting. To enhance understanding, our study aimed to chart these caregivers' psycho-emotional evolutions felt during such caregiving experiences in Singapore. METHOD: Utilizing purposive sampling, a descriptive phenomenological study was performed, with semi-structured interviews of 10 caregivers of persons on nasogastric tube feeding conducted. Thematic analysis was utilized. RESULTS: Our findings chart four psycho-emotional transitions of a caregiver's journey in nasogastric tube feeding and the cultural dynamics involved-(a) Disruption of Caregivers' Normality: Attempting to Grasp Reality, (b) Encountering Road-Blocks: Despondency Arises and Frustrations Abound, (c) Adjusting to the New Normal: Reclaiming Confidence and Positivity, (d) Thriving and Integrating into the New Normal, and (e) Cultural Dynamics At Play. DISCUSSION: Our findings illuminate the understanding of caregivers' varying needs, guiding delivery of culturally-congruent caregiver support targeted at each psycho-emotional evolution.

I see, I learn, I do: Development and evaluation of a video-enhanced nasogastric tube feeding training programme for caregivers.

AIM: We examined the effectiveness of a video-enhanced education package in improving caregiver outcomes (number of steps at first feeding attempt, time to achieve competency and knowledge) compared to the current institutional training approach. DESIGN: Quasi-experiment. METHODS: From August 2016-June 2017, we recruited 112 caregivers in a Singaporean tertiary hospital. We allocated 72 and 40 caregivers to video-enhanced and standard education, respectively. Median values are reported with interquartile ranges (IQR), and analysed using Mann-Whitney U test. RESULTS: Caregivers taught with our video-enhanced package performed a median of 7.0 (IQR = 3.5-7.5) out of eight steps correctly at their first attempt, a 40% increase. There was no change in the median number of training sessions but the 75th percentile dropped to 9.3 from 6.0, a 35% reduction. Post-training knowledge improved from a median of 0.5 (IQR = 0-2.0) to 1.0 (IQR = 0-3.0). The video-enhanced package can improve caregivers' knowledge and accelerate their skill competency.

'24/7' Caregiving: A Qualitative Analysis of an Emerging Phenomenon of Interest in Caregiving.

The COVID-19 pandemic has exacerbated the difficulties faced by caregivers who have to provide continuous '24/7' care to persons with dementia with minimal formal and informal support. While caregivers have reported heightened levels of caregiving distress and burden during the pandemic, there remains a dearth of research pertaining to their lived experiences of providing continuous care with little respite and the corresponding physical, psychosocial and emotional impacts of caregiving '24/7'. The present study uses data obtained from interviews with dementia caregivers (N = seven) that were collected as part of a larger study on Carer Matters, a hospital-based holistic caregiver support program held during COVID-19, to conduct a secondary thematic analysis. The findings revealed three themes that defined the shared experiences of '24/7' caregivers: (1) A World Overturned, which refers to the increase in caregiving intensity and burden due to the pandemic; (2) Burning on Both Ends, which refers to the impossible balance between caregiving and their personal lives; and (3) At Wits' End, which refers to an overwhelming sense of hopelessness and helplessness over their caregiving situation. These findings highlight the challenges and unsustainability of '24/7' caregiving and the detrimental impact that round-the-clock care wields on caregivers' physical and mental well-being. Implications and recommendations are discussed in accordance with the cultural particularities of the study's Asian context (Singapore), with calls for greater caregiver support to be better integrated into society and the community, especially at the neighborhood and grassroots level, to alleviate caregiving burden and safeguard their well-being.

Applying the RE-AIM framework to evaluate a holistic caregiver-centric hospital-to-home programme: a feasibility study on Carer Matters.

BACKGROUND: Prolonged caregiving of an older adult can cause family caregivers to be overwhelmed, potentially affecting the well-being of both the caregivers and their care-recipients. Carer Matters is a holistic hospital-to-home programme, centred on caregivers' needs as their care-recipients transit from hospital to home. The programme was piloted to support caregivers through caregivers needs assessment, tailored resources, tele-support, training courses, and community support network. This study aimed to examine the feasibility of Carer Matters in a tertiary hospital in Singapore. METHODS: This feasibility study was conducted on the pilot implementation from January to December 2021, during the Covid-19 pandemic. It adopted the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. The study highlighted quantitative data collected from key process indicators, such as number of caregivers screened, assessed on their needs and provided with assistance. Additionally, qualitative data was collected from in-depth interviews with 51 stakeholders involved in the implementation to examine their perspectives and experiences. These included family caregivers, clinician caregiver support nurses, hospital leaders and community partners. RESULTS: During the pilot, 550 caregivers were enrolled. All caregivers received educational resources when they completed the needs assessment, while 69 of them who reported high burden were given tele-support and 252 attended our caregiver training courses. Despite initial recruitment challenges and obstacles to adoption, stakeholders interviewed found Carer Matters to be effective in providing caregivers with emotional support, knowledge and skills that improved their caregiving abilities, and reduced their sense of isolation and caregiving stress. Among caregivers, the training courses were effective with majority of caregivers agreeing that the courses addressed their needs (99%) and improved their knowledge of the relevant disease conditions (97%). Programme maintenance considered among stakeholders included strategies such as multipronged approach in recruiting caregivers and inviting caregiver advocates to share their experiences. CONCLUSION: This feasibility study highlights that Carer Matters is a valuable component to the ecosystem of support for family caregivers and their care recipients. Carer Matters extends the current patient-centric care model to a more holistic post-discharge continuity of care for both caregivers and their care-recipients, improving and maintaining their overall well-being to better allow transition from hospital-to home. TRIAL REGISTRATION: Feasibility Study of Project Carer Matters for Family Caregivers of Persons with Dementia (NCT number: NCT05205135 ).

Delivering a holistic hospital-to-home framework to support family caregivers of persons with dementia: Protocol for a feasibility study.

AIM: To evaluate the feasibility of the Carer Matters holistic hospital-to-home framework for family caregivers of people with dementia. BACKGROUND: Family caregivers of persons with dementia face a unique blend of stressors, from behavioural management to navigating the healthcare system. It is important to provide support and assistance to help caregivers cope to enable a sustained capacity for caregiving. This led to our establishment of Carer Matters, the first holistic caregiver-centric hospital-to-home framework of support for caregivers of persons with dementia in Singapore. METHODS: A multimethod study design will be used. We will assess the programme's feasibility and effectiveness using a Theory of Change approach, with findings synthesized using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Our study will involve six inpatient wards of a 1700-bedded acute care hospital over 12 months. Qualitative data will be obtained from interviews of stakeholders-caregivers, healthcare professionals, hospital leaders and community leaders. Quantitative data will be collected from programme logs, surveys and evaluation forms that capture self-reported levels of mastery, anxiety, burden, and depression. Funding has been approved by the Geriatric Education and Research Institute (GERI) Intramural Project Grant (GERI Ref: GERI1626) on May 2020 for this study (£103,659), to be conducted from December 2020 to June 2022. DISCUSSION: The stresses faced by caregivers of persons with dementia are wide and complex, necessitating a multi-faceted caregiver-oriented solution to provide sustained support, empower better management and continued capacity to care. Our study would provide insights on the feasibility and effectiveness of a caregiver-centric support programme stretching from the hospital into the community. IMPACT: These findings will provide a blueprint on how to implement a hospital-to-home patient-caregiver framework and provide policymakers, clinicians, and advocacy groups with critical insights on the potential patient-caregiver-healthcare system outcomes that can be derived.

Four of a kind: Salient caregiver archetypes to better understand the psychosocial needs and behavioral patterns of dementia caregivers in Singapore.

BACKGROUND: Family caregivers' lived experiences are often perceived as a homogenous entity, preventing effective identification of unique caregiving needs and appropriate support. Our study examined and classified the varying dementia caregiving experiences in an Asian setting, through establishing caregiver archetypes. METHODS: Secondary analysis of semi-structured interviews conducted with 16 dementia family caregivers in a Singapore hospital was performed. Thematic analysis and typological analysis were utilized. RESULTS: Four caregiver archetypes (Reluctant, Ambivalent, Enlightened, and Selfless) were identified: Reluctant caregivers possessed poor understanding of dementia and experienced immeasurable distress; Ambivalent caregivers carried mixed feelings towards caregiving and felt unsupported; Enlightened caregivers preserved care-recipients' dignity and accepted challenges with priority on sustainable care; Selfless caregivers were overly-devoted and enmeshed in the caregiver identity. CONCLUSION: Our findings are useful in providing a framework for: (1) rapid understanding of informal caregivers' varying needs, (2) targeted support in a holistic caregiver-centered manner.

Effectiveness of skin cleanser and protectant regimen on incontinence-associated dermatitis outcomes in acute care patients: A cluster randomised trial.

Skin cleansers and protectants protect skin from incontinent matter to reduce the risk of incontinence-associated dermatitis (IAD), but their effectiveness treating established IAD in the tropics is unknown. We conducted an open-label cluster randomised trial to compare the effectiveness of a combined regimen of (1) specialised skin cleansers with disposable body wipes and (2) either an acrylic terpolymer (T1) or zinc oxide (T2) skin protectant against disposable body wipes and zinc oxide protectant (control) in promoting IAD healing and reducing the risk of deterioration. Eighty-four patients were recruited in a tertiary hospital in Singapore between April 2019 and January 2020 (T1: n = 23; T2: n = 37; Control: n = 24). Although not statistically significant, patients treated with T1 and T2 were 1.5 times as likely to experience IAD healing within seven days compared with the control (P = .66). Healing was more pronounced in participants with skin loss treated with T1 or T2. No treatment was superior in preventing IAD deterioration, the prevalence of which remained small (8%-14%). While skin cleaning and protectants reduced the overall risk of skin deterioration, the addition of skin cleansers enhanced IAD healing within a short period, an important consideration for future research examining IAD treatment in acute care.

Health literacy and patient activation among adults with chronic diseases in Singapore: A cross-sectional study.

AIMS: Increased patient activation levels can improve health outcomes. Hence, this study aims to examine the relationships between sociodemographic variables and domain-specific health literacies with patient activation. DESIGN: A cross-sectional design. METHODS: 200 outpatient adults with chronic diseases completed a survey that assessed their domain-specific health literacy and patient activation levels. Univariate and multivariate analysis of the variables were conducted on patient activation with 95% confidence interval (CI). RESULTS: Multiple linear regression analyses observed a positive linear relationship between the following domain-specific health literacy variables-"actively manage my health" (p < .0001, 95% CI: 0.89-2.29), "understanding health information" (p = .008, 95% CI: 0.28-1.85), and "finding good health information" (p = .02, 95% CI 0.13-1.51) with patient activation. The other sociodemographic and clinical variables were not statistically significant. Increased focus from healthcare professionals is needed on helping patients better find and understand health information and encouraging them to actively manage their health; elements which would raise their activation levels.

Patient Activation and its Predictors in Hospitalized Older Adults in Singapore.

BACKGROUND: Patient activation is critical in hospitalized older adults preparing for discharge as it enhances their ability to self-care at home. Little is known about how person-centred care and demographic predictors could influence activation in Asian patients. AIMS: To explore patient activation and its predictors in hospitalized older adults in Singapore. METHODS: Multi-centre cross-sectional survey of hospitalized older adults. Multivariable analysis conducted with age, gender, education, socioeconomic status, functional dependency and perception of person-centred care as potential predictors to patient activation. RESULTS: 300 older adults were surveyed, 65% were at the top two levels of activation. Perception of person-centred nursing care was the strongest predictor with the largest effect on patient activation, (ß=0.22, b=3.48, 95% CI:1.70-5.26, p<0.001). Other predictors were age, education, income and independence in care. CONCLUSION: Our study highlights the importance of person-centred nursing care in raising patient activation in hospitalized older adults, enhancing their capacity to self-care.

Effect of an evidence-based poster on the knowledge of delirium and its prevention in student nurses: A quasi-experimental study.

BACKGROUND: A major barrier to nurses adopting evidence-based practice (EBP) has been the limited awareness of evidence underpinning clinical practice, often due to poor access and understanding of the literature base. To address this, we piloted the development of educational posters summarizing the evidence base around clinical practices to see if they help nurses better understand the rationale behind their care. Our first poster focused on the evidence supporting the management of delirium in older persons, specifically delirium identification and its prevention. OBJECTIVE: To examine the effect of an evidence-based poster education on the delirium knowledge of student nurses. DESIGN: A prospective two-armed quasi-experimental study. METHODS: 188 student nurses were recruited in December 2017. Participants were alternated to receive either an evidence-based poster education session or a reflective education session as a control. Both groups were assessed on their general knowledge on delirium, knowledge on delirium detection and knowledge on delirium prevention. This was conducted both before exposure to either the intervention or control, and one week after exposure. Unpaired t-tests with 95% confidence intervals (CI) were applied to compare the mean change in pre-test and post-test delirium knowledge. We used the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist to report our methods and findings. RESULTS: Students in the poster education group reported greater improvements in mean scores of delirium identification (Mean increase = 1.0, p = 0.007, 95% CI: 0.3-1.6), delirium prevention (Mean increase = 1.6, p < 0.001, 9% CI: 1.0-2.2) and overall delirium knowledge (Mean increase = 2.7, p < 0.001, 95% CI: 1.5-3.8) than students in the control. CONCLUSION: Summarised research evidence within a poster format can increase student nurses' access to the evidence base. This has shown to increase their knowledge to guide their clinical practice. IMPACT STATEMENT: Exposure to poster summaries of research evidence underpinning delirium care increases student nurses' clinical knowledge of delirium identification and prevention.

Evaluation of a Hospital-Based Nursing Research and Evidence-Based Practice Mentorship Program on Improving Nurses' Knowledge, Attitudes, and Evidence-Based Practice.

BACKGROUND: Evidence-based practice (EBP) is a core requirement for nurses, contributing toward better clinical outcomes. Mentorship could prepare early adopters of EBP to create an EBP culture. METHOD: Nine nurses in an acute hospital in Singapore participated in a mentorship program throughout 2015. Mentees conducted ward-based EBP education sessions for nursing colleagues. The Evidence-Based Practice Questionnaire (EBPQ) was used to measure the program's effect on mentees' and their ward colleagues' knowledge, attitude, and practice of EBP. Both groups completed the EBPQ before and 3 months after completion of the program. Wilcoxon rank-sum tests were performed to compare changes in EBPQ scores. RESULTS: Both mentees and ward colleagues reported improved posttest median scores for all EBPQ subscales and the overall score. However, mentees reported a larger magnitude of improvement. CONCLUSION: A hospital-based research and EBP mentorship program increases nurses' knowledge, attitude, and practice of EBP, creating an EBP culture change. [J Contin Educ Nurs. 2020;51(1):46-52.].

Crossing, Trudging and Settling: A phenomenological inquiry into lived experience of Asian family caregivers of older persons with dementia.

Throughout Asian societies, family members often adopt the role of caregiving for older persons, providing essential care for loved ones with dementia. To date, there has been limited insight into the lived experience and meaning ascribed to the journey of these caregivers. This descriptive phenomenological study aims to explore the lived experience of Asian family caregivers of persons with dementia. Semi-structured face-to-face interviews were conducted with 16 family members caring for aged persons with dementia. Interviews were audio-recorded and data analysed using Colaizzi's technique. Analysis revealed the essential structure of a caregiver's journey with three major transitions, namely: (1) Crossing the threshold from ordinary world into caregiving world, (2) Trudging on the road of trials and obstacles, and (3) Settling into a new normalcy. Understanding the lived experience of Asian caregivers can help clinicians in targeting relevant support and information, and prepare new caregivers for the demands of their role.