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BACKGROUND: Cancer caregivers experience significant stress due to their multifaceted role. Current support methods are limited by unidimensional assessments. OBJECTIVE: The aim of this study was to evaluate a Web-based support system aimed at reducing caregiver stress and anxiety, and improving resilience, vigilance, and quality of life, using both subjective and objective measures. METHODS: A randomized controlled trial with a single-center, 2-arm parallel design and longitudinal assessment was conducted in Taiwan. Caregivers of patients recently diagnosed with cancer were randomly allocated to either a standard care group or an intervention group that received enhanced nurse-led support. Metrics including psychological resilience, caregiver burden, anxiety, quality of life, stress levels, and vigilance were systematically evaluated on a monthly basis over a period of 5 months, starting from the initial baseline measurement. RESULTS: Following the intervention, participants in the intervention group exhibited statistically significant reductions in caregiver burden and anxiety, alongside a notable improvement in resilience. Objective evaluations revealed a significant reduction in stress levels within this group. However, there were no discernible differences in vigilance and quality of life metrics between the intervention and control groups. CONCLUSION: The Web-based program effectively reduced caregiver stress and burden, as indicated by multiple metrics. IMPLICATIONS FOR PRACTICE: This accessible and efficient Web-based support is beneficial for cancer caregivers facing diverse challenges.
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BACKGROUND: Poor disease control in patients with chronic obstructive pulmonary disease (COPD) is associated with suboptimal inhaler use. PURPOSE: This study was designed to explore the accuracy of inhaler use and related factors in elderly patients with COPD. METHODS: A cross-sectional survey design was used to recruit patients with COPD from a medical centre in southern Taiwan who were over 65 years old and used inhalers regularly. All of the data as well as information on inhaler use accuracy were collected using a self-designed questionnaire and inhaler operation checklist. Multivariable logistic regression was used to analyse significant correlates of correct inhaler operation. RESULTS: The average age of the 150 participants was 75.0 years (SD = 7.5) years. Most used one type of inhaler only (86.0%). The rate of accurate inhaler operation was 40.7% (n = 61) for the sample, with dry powder inhalers associated with the highest accuracy (64%) and pressurized metered-dose inhalers associated with the lowest accuracy (1.6%). Multivariate logistic regression analysis showed that using a soft mist inhaler (adjusted odds ratio, AOR = 23.29; 95% confidence interval, 95% CI [2.84, 191.07]), using a dry powder inhaler (AOR =15.60, 95% CI [1.99, 122.26]), and higher satisfaction with the inhaler were positively and independently associated with accurate inhaler use (AOR = 1.94, 95% CI [1.09, 3.44]). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Important factors related to inhaler use accuracy include inhaler type and level of patient satisfaction with their inhaler. Healthcare professionals should regularly confirm that older patients are able to use their inhalers correctly and are satisfied with their inhalers.
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Nebulizadores e Vaporizadores , Doença Pulmonar Obstrutiva Crônica , Humanos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Idoso , Masculino , Feminino , Estudos Transversais , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Caregiving burden is common among family caregivers (FCs). In Taiwan, no reports have compared caregiving burden according to disease stage, or explored the comprehensive factors of caregiving burden in the FCs of patients with hepatocellular carcinoma (HCC). AIM: The aim of the study was to investigate caregiving burden at different diagnosis stages and its potential predictors in the FCs of patients with hepatocellular carcinoma. METHODS: This descriptive, cross-sectional study included 192 FCs. Caregiving burden was measured using the Caregiver Reaction Assessment tool. The predictive factors of caregiving burden in the FCs of patients with HCC were identified using a linear regression model. RESULTS: The global caregiving burden had no significant differences between the four disease stages. The lack of family support and impact on schedule were significantly higher at the terminal stage than at the earlier stage. The risk factors of caregiving burden were high depression, high financial demand, heavy caregiving tasks, advanced age and frequent patient contact, which obtained a variance of 47.8% in the regression model. CONCLUSION: Healthcare providers need to proactively identify and assess FCs with risk factors of caregiving burden and provide appropriate interventions specific to individual needs at different disease stages.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Estudos Transversais , Efeitos Psicossociais da Doença , Cuidadores , FamíliaRESUMO
This study aimed to compare the diagnostic values of SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls), SARC-Calf (SARC-F combined with calf circumference), CC (calf circumference), and the Yubi-wakka (finger-ring) test for screening for sarcopenia in community-dwelling older adults. The Asian Working Group for Sarcopenia (AWGS) 2019 criteria were used as a standard reference. A total of 209 participants were enrolled, and 40.7% were identified as sarcopenia. The sensitivity, specificity, and AUC were respectively 54.1%, 70.2%, and 0.687 for SARC-F; 76.5%, 73.4% and 0.832 for SARC-calf, 86.7%, 82.4%, and 0.906 for CC in men, and 85.5%, 63.3%, and 0.877 for CC in women. Relative to the "bigger," a significant association between sarcopenia and the Yubi-wakka test ("just fits" OR: 4.1, 95% CI: 1.57-10.98; "small" OR: 27.5, 95% CI: 10.14-74.55) was observed. The overall accuracy of CC was better than SARC-Calf for sarcopenia screening.
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Sarcopenia , Masculino , Humanos , Feminino , Idoso , Sarcopenia/diagnóstico , Vida Independente , Perna (Membro) , Caminhada , Avaliação Geriátrica/métodos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Despite a public information campaign "To Break the Myth of Fever", nurses continued to overtreat fever. This study hypothesized that the campaign lacked the detailed rationale essential to alter nurses' attitudes and behaviors. AIM: To evaluate the effect of the educational program on nurses' knowledge, attitudes, and behaviors related to fever management. DESIGN: A randomized experimental design using a time series analysis. METHODS: A random sample of 58 medical/surgical nurses was evenly divided into an intervention and a control group. The intervention group received an educational program on fever and fever management. Both groups completed a pretest and four posttests using investigator-developed instruments: a questionnaire on knowledge and attitudes about fever management and a fever treatment checklist to audit charts. RESULTS: The intervention group had markedly higher knowledge scores and reduced use of ice pillows at all four posttests, as well as lower use of antipyretics overall, except for the first posttest, despite no sustained change in attitude. CONCLUSIONS: An educational program for fever management can effectively improve clinical nurses' knowledge and attitudes about fever management.
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BACKGROUND: Functional decline and increased dependence on others are common health issues among hospitalized elderly patients. However, a well-validated screening tool for predicting functional decline in elderly patients is still lacking. The current study therefore aimed to evaluate and compare the diagnostic accuracy of the Identification of Seniors at Risk-Hospitalized Patients (ISAR-HP), Variable Indicative of Placement Risk (VIP), and Score Hospitalier d' Evaluation du Risque de Perte d'Autonomie (SHERPA) in predicting functional decline 30 days after discharge in older patients admitted to an acute hospital ward. METHODS: A prospective, longitudinal study was conducted in 197 elderly inpatients at the internal medicine ward of a teaching hospital in central Taiwan. Data were collected twice, first within 48 h after hospitalization and second via a telephone interview 30 days after hospital discharge. Variables included demographic data, Barthel Index of activities of daily living (ADL), and screening instruments. The Barthel Index was used to measure functional disability. Functional decline was defined as a decline of at least five points on the Barthel Index 30 days after discharge compared to that at pre-admission. RESULTS: Patients had a mean age of 77.7 years, with 55.7% being female. Functional decline was observed in 39.1% of all patients. The best cutoff point, sensitivity, specificity, and area under the receiver operating characteristic curve were 2.5, 96.1%, 52.5%, and 0.751 for ISAR-HP; 1.5, 83.1%, 62.5%, and 0.761 for VIP; and 4.75, 89.6%, 54.2%, and 0.758 for SHERPA, respectively. CONCLUSIONS: All three instruments showed moderate diagnostic accuracy as indicated by their best cutoff points. Therefore, the results presented herein can guide health care professionals in selecting the appropriate assessment tool for predicting functional decline among hospitalized elderly patients in a clinical setting.
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Atividades Cotidianas , Avaliação Geriátrica , Idoso , Feminino , Avaliação Geriátrica/métodos , Hospitalização , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Medição de Risco/métodos , Fatores de RiscoRESUMO
BACKGROUND: Family caregivers (FCs) commonly experience fatigue during caregiving. The factors of fatigue in the FCs of patients with advanced cancer have not yet been investigated in Taiwan. OBJECTIVE: This study investigated potential predictors of fatigue in the FCs of patients with advanced cancer. METHODS: A descriptive, cross-sectional study was conducted on 184 FCs. Data were collected using the Checklist Individual Strength and the palm-based psychomotor vigilance test. A linear regression model was the main statistical method for identifying the factors predictive of fatigue in FCs. RESULTS: Subjective and objective measurements revealed that 95% of the FCs had fatigue and poor vigilance. Those who spent more time each day on caregiving tasks, had no religious beliefs, had a full- or part-time job, and had a greater caregiver burden experienced greater fatigue. CONCLUSIONS: Fatigue and poor vigilance were common in the Taiwanese FCs of patients with advanced cancer. Family caregivers with risk factors for fatigue must be identified and given access to resources for assistance. IMPLICATION FOR PRACTICE: Healthcare providers must proactively assess FCs for fatigue and vigilance status and provide interventions appropriate for individual needs.
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Cuidadores , Neoplasias , Estudos Transversais , Fadiga/etiologia , Humanos , Neoplasias/complicações , Neoplasias/terapia , Fatores de RiscoRESUMO
BACKGROUND: Sleep disturbances are common among family caregivers (FCs) of patients with advanced cancer. Self-administered acupressure can combat insomnia, but no study has been conducted to evaluate its efficacy in caregivers of patients with advanced cancer. OBJECTIVE: The aim of this study is to investigate whether self-administered acupressure improves sleep quality for FCs of patients with advanced cancer. METHODS: Family caregivers of patients with advanced cancer who reported sleep disturbance (Pittsburgh Sleep Quality Index scores >5 in recent months) were recruited. The experimental group self-administered acupressure at the Baihui (GV20), Fengchi (GB20), Neiguan (PC6), and Shenmen (HT7) points over a 12-week period, whereas the comparison group received sleep hygiene education. Sleep quality was assessed subjectively at 4, 8, and 12 weeks after the intervention using the Pittsburgh Sleep Quality Index and objectively using actigraphy measurements. Improvements in sleep quality were analyzed using a generalized estimating equation. RESULTS: Compared with the control group, the experimental group demonstrated significantly lower sleep latency (Wald χ2 = 11.49, P = .001) and significantly better sleep efficiency (Wald χ2 = 5.24, P = .02) according to actigraphy measurements, but Pittsburgh Sleep Quality Index scores did not differ significantly between the groups. CONCLUSIONS: Self-administered acupressure did not demonstrate favorable effects on subjective sleep quality, but did reduce sleep latency and improve sleep efficiency, according to actigraphy measurements. Self-administered acupressure may help relaxation and sedation and promote sleep in FCs. IMPLICATIONS FOR PRACTICE: Healthcare providers may consider advising FCs to apply this self-administered acupressure to improve their sleep latency and sleep efficiency.
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Acupressão , Neoplasias , Distúrbios do Início e da Manutenção do Sono , Cuidadores , Humanos , Neoplasias/complicações , Neoplasias/terapia , Distúrbios do Início e da Manutenção do Sono/terapia , Qualidade do Sono , Resultado do TratamentoRESUMO
Background and Aim: Patients with leukemia who are isolated in positive pressure rooms for infection prevention usually experience significant physical and psychological distress. This study aimed to examine changes in leukemia patients' comfort level during chemotherapy in isolation wards. Methods: A longitudinal survey was conducted with measures which were repeated four times. Data were collected before chemotherapy, on the first and second week after receiving chemotherapy in positive pressure isolation rooms, and on the third week in the non-isolated hematology ward. Each patient received six questionnaires measuring demographic data, comfort status, functional status, fatigue related to cancer therapy, anxiety level, and distress symptoms. A mixed model with repeated measure analysis was used to examine the changing trajectories in physical and psychological health. Results: Twenty-one patients completed the study. During the process, the highest score for comfort level was shown before chemotherapy, and this decreased from the second week under isolation. Anxiety and uncertainty (p < 0.05) declined over time, and emotional states improved during the recovery period in the third and fourth weeks outside isolation. Physical well-being (p < 0.01), cancer-related fatigue (p < 0.05), hemoglobin (p < 0.01) and white blood cell count (p < 0.05) began to rise two weeks after chemotherapy. Conclusion: Comfort levels declined after chemotherapy until the third week of treatment. Anxiety, fatigue and distress symptoms varied across the four time points of chemotherapy from isolation to return to the non-isolated ward. Health care professionals should be aware of psychological symptoms when patients are in isolation rooms, and interventions for promoting a humanized environment, quality of life, and comfort should be considered and provided along with the treatment stages of chemotherapy.
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Leucemia , Isolamento de Pacientes , Respiração com Pressão Positiva , Qualidade de Vida , Ansiedade , Transtornos de Ansiedade , Fadiga , Humanos , Leucemia/terapiaRESUMO
BACKGROUND: Assessing clinical competency in undergraduate nursing students is essential before they enter clinical practice. The objective structured clinical examination (OSCE) is widely used and is part of clinical competency assessment. Aim The aim of this study was to develop and validate a six-station OSCE for evaluating the clinical competency of the student nurses before graduation. METHODS: One-group longitudinal observational study. An OSCE of 6 stations of 10â¯min each was adopted. Blueprint setting, checklist development, and standard patient and examiner training were conducted. The mean, standard deviation, item scale (item-total correlation) and comparisons of extreme groups for item analysis. The inter-coder of examiners and inter-case of students were used to test reliability. Content Validity and concurrent validity were used to evaluate validity of OSCE. RESULTS: One hundred nursing students participated in this study. The mean OSCE score of students who passed the registered nurses' examination was significantly higher than that of students who failed. Significant differences in OSCE score between students who remain versus left clinical job were observed at 3, 6 and 9â¯months after graduation. CONCLUSION: The OSCE is predictable method for assessing undergraduate students' first year clinical retention.
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Competência Clínica , Avaliação Educacional , Estudantes de Enfermagem/psicologia , Bacharelado em Enfermagem , Feminino , Humanos , Estudos Longitudinais , Masculino , Reprodutibilidade dos Testes , Adulto JovemRESUMO
AIMS AND OBJECTIVES: To examine changes in patients' bowel function and to compare patients' outcome among different operation and treatment after rectal resection. BACKGROUND: Anal-preserving surgery is the trend of treatment of colorectal cancer and bowel function after surgery needs to be concerned. DESIGN: Prospective cohort study. METHODS: A total of 38 patients with convenience sampling were recruited from a teaching hospital. The low anterior resection syndrome (LARS) score was used to assess bowel function disturbances before discharge and at 1 week, 1 month and 3 months after discharge. We followed the STROBE checklist to ensure rigour in our study. RESULTS: Approximately half of the patients experienced major LARS, including daily stool frequency of more than seven times and stool clustering at least once a week. The LARS scores observed at 1 month after discharge were significantly higher than those observed before discharge. Patients who received intersphincteric resection had higher LARS scores compared with those who received other surgeries. Furthermore, patients who underwent concurrent chemoradiotherapy, operation (OP) and chemotherapy had the highest LARS scores compared with those who underwent only an OP. CONCLUSION: The patients experienced varied intestinal dysfunction after surgery based on their treatment plan and surgical method. Nurses should provide individualised health education for these patients. RELEVANCE TO CLINICAL PRACTICE: A health education booklet is recommended to educate patients about LARS symptoms and the techniques to adapt in their daily lives after surgery.
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Canal Anal/cirurgia , Cirurgia Colorretal/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Incontinência Fecal/etiologia , Complicações Pós-Operatórias/etiologia , Neoplasias Retais/cirurgia , Reto/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Defecação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Dementia is characterized by prolonged progressive disability. Therefore, predicting mortality is difficult. An accurate prediction tool may be useful to ensure that end-of-life patients with dementia receive timely palliative care. PURPOSE: This study aims to establish a survival prediction model for elderly patients with dementia in Taiwan. METHODS: Data from the 2001 to 2010 National Health Insurance Research Database in Taiwan were used to identify 37,289 patients with dementia aged ≥65 years for inclusion in this retrospective longitudinal study. Moreover, this study examined the mortality indicators for dementia among demographic characteristics, chronic physical comorbidities, and medical procedures. A Cox proportional hazards model with time-dependent covariates was used to estimate mortality risk, and risk score functions were formulated using a point system to establish a survival prediction model. The prediction model was then tested using the area under the receiver operating characteristic curve. RESULTS: Thirteen mortality risk factors were identified: age, sex, stroke, chronic renal failure, liver cirrhosis, cancer, pressure injury, and retrospectively retrieved factors occurring in the 6 months before death, including nasogastric tube placement, supplemental oxygen supply, ≥2 hospitalization, receiving ≥1 emergency services, ≥2 occurrences of cardiopulmonary resuscitation, and receiving ≥2 endotracheal intubations. The area under the receiver operating characteristic curves for this prediction model for mortality at 6 and 12 months were 0.726 and 0.733, respectively. CONCLUSIONS: The survival prediction model demonstrated moderate accuracy for predicting mortality at 6 and 12 months before death in elderly patients with dementia. This tool may be valuable for helping health care providers and family caregivers to make end-of-life care decisions.
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Demência/mortalidade , Fibrose/mortalidade , Psiquiatria Geriátrica , Falência Renal Crônica/mortalidade , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Demência/complicações , Demência/fisiopatologia , Feminino , Fibrose/fisiopatologia , Previsões , Geriatria/tendências , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/fisiopatologia , Estudos Longitudinais , Masculino , Mortalidade , Oxigênio , Fatores de Risco , Assistência TerminalRESUMO
BACKGROUND: Empathy is an important clinical skill for nursing students, but it is a characteristic difficult to teach and assess. OBJECTIVE: To evaluate the effect of situated teaching on empathy learning among undergraduate nursing students. DESIGN: A cohort study with pre-post-test quasi-experimental design. PARTICIPANTS AND SETTING: The 2nd-year students were enrolled from two BSN programs. METHODS: The teaching program was completed over 4â¯months on the basis of experiential learning theory which integrated the following four elements: classroom-based role play, self-reflection, situated learning and acting. The Jefferson Scale of Empathy-Health Profession-Student version was administered before and after the program. Objective Structure Clinical Examination (OSCE) was administered at the end of program and a rubrics scale was used to measure empathy. A generalized estimation equation was used to identify the effect of subjective empathy, and an independent t-test was used for the objective assessment between two groups. RESULTS: A total of 103 students were enrolled. The results showed that subjective empathy increased significantly in experimental group. In the Objective Structured Clinical Examination, examiners and standard patients gave significantly higher empathy scores to the situated teaching group than the control group. CONCLUSIONS: The present study indicated that situated teaching can improve empathy learning of the nursing students. However different methods of assessment of empathy produce different results. We therefore recommend that multiple measurements from difference perspectives are preferable in the assessment of empathy.
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Avaliação Educacional/métodos , Empatia , Aprendizagem Baseada em Problemas/métodos , Estudantes de Enfermagem/psicologia , Competência Clínica , Estudos de Coortes , Bacharelado em Enfermagem , Feminino , Humanos , Masculino , Simulação de PacienteRESUMO
OBJECTIVE: This study tested the maintenance outcomes of a 3-month Sit Less, Walk More (SLWM) workplace intervention for office workers compared with usual care at 12 months from the baseline. METHOD: A quasi-experimental study was conducted in two workplaces. The intervention group (nâ=â51) received multi-component intervention and the comparison group (nâ=â50) received newsletters only. The outcomes of the study (self-reported psychosocial, physical activity, sitting, and lost productivity; objectively measured cardiometabolic biomarkers) were compared at baseline, 3, and 12 months. RESULTS: Generalized estimating equations analyses found that the intervention group had significant improvements in self-regulation for sitting less and moving more (Pâ=â0.017), walking (Pâ=â0.003), weight (Pâ=â0.013), waist circumference (Pâ=â0.002), and insulin (Pâ=â0.000) at 12 months compared with the comparison group. CONCLUSION: The SLWM intervention was effective in improving self-regulation, walking, and some cardiometabolic biomarkers in office workers.
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Promoção da Saúde/métodos , Saúde Ocupacional , Postura Sentada , Caminhada/fisiologia , Acelerometria , Pressão Sanguínea , Peso Corporal , Sinais (Psicologia) , Eficiência , Feminino , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Motivação , Cultura Organizacional , Publicações Periódicas como Assunto , Comportamento Sedentário , Autoeficácia , Autocontrole , Circunferência da Cintura , Local de TrabalhoRESUMO
BACKGROUND: Sleep disturbance commonly has a negative impact on the well-being of family caregivers (FCs) of terminally ill patients with cancer. The effect of sleep disturbance on FCs has not been explored through long-term follow-up studies in Taiwan. OBJECTIVE: The purposes of this study were to (1) identify the trajectory of sleep quality of FCs of terminally ill patients with cancer in Taiwan and (2) examine the determinants of sleep disturbance through a longitudinal follow-up until patient death. METHODS: A prospective, longitudinal study was conducted among 95 FCs of terminally ill patients with cancer. The FCs' sleep quality was measured subjectively by using the Pittsburgh Sleep Quality Index and objectively by wearing a wrist actigraphy for 48 hours each month during the 6-month follow-up assessments. The trajectory and determinants of sleep quality were identified using a generalized estimation equation approach. RESULTS: The FCs' sleep quality significantly decreased as the patient's death approached. Family caregivers who were women or older, had a relative with a longer survival period after diagnosis, reported higher levels of depression and fatigue, and provided lower levels of assistance to their relatives experienced more sleep disturbance. CONCLUSION: The sleep quality of Taiwanese FCs significantly deteriorated as the death of the terminally ill patients with cancer approached. Early detection of the FCs' sleep disturbance, increasing their self-awareness of sleep problems, and providing nonpharmacological interventions and psychosocial support may be helpful for FCs to improve their quantity and quality of sleep.
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Cuidadores/psicologia , Família/psicologia , Neoplasias/epidemiologia , Transtornos do Sono-Vigília/psicologia , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais , Taiwan , Fatores de TempoRESUMO
OBJECTIVE: The aim of this study was to test the short-term efficacy of the Sit Less, Walk More (SLWM) workplace intervention. METHODS: This was a quasi-experimental design. A total of 99 office workers from two workplaces participated in this study. The 12-week intervention included five components: monthly newsletters, motivational tools, pedometer challenge, environmental prompts, and walking route. The comparison group received monthly newsletters only. RESULTS: Generalized estimating equation analyses showed that the intervention group demonstrated significant improvements in weight (Pâ=â0.029), waist circumference (Pâ=â0.038), diastolic blood pressure (Pâ<â0.001), walking (Pâ<â0.001), moderate-intensity physical activity (Pâ=â0.014), and total physical activity (Pâ=â0.003) relative to the comparison group. A significant improvement in lost-productivity was observed in both groups (Pâ=â0.003 to 0.008). CONCLUSIONS: The SLWM workplace intervention can improve worker health and lost-productivity.
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Promoção da Saúde/métodos , Saúde Ocupacional , Caminhada/fisiologia , Local de Trabalho , Acelerometria , Adulto , Pressão Sanguínea , Peso Corporal , Eficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Jornais como Assunto , Esforço Físico , Avaliação de Programas e Projetos de Saúde , Fatores de Tempo , Circunferência da CinturaRESUMO
BACKGROUND: Previous studies have shown small-to-medium effects of support on reducing the caregiver burden for advanced cancer patients. A dearth of studies utilized longitudinal design to examine and evaluate the effect of support for the caregiving burden till the patient's death. OBJECTIVES: To test the ability of an integrative intervention program for caregivers of advanced cancer patients to lower caregiving burden as death approaches. DESIGN: A two-group comparative design with repeated measures. SETTING: Two cancer wards of a single university hospital. PARTICIPANTS: Advanced cancer patients (N=81) and their caregivers were allocated into two groups: an experimental group (N=40) receiving coping strategies, assistance, recourses, and education intervention and a control group (N=41) receiving standard care. METHODS: Caregivers received training in the caregiver support intervention at least 3 times every 2 weeks to help them reduce their caregiving burden. Subjective (Caregiver Reaction Assessment) and objective (Heart Rate Variability) measures of caregiver burden were evaluated for caregivers of patients approaching death. Only data within 3 months before the patients' death were analyzed. RESULTS: Caregiver self-efficacy significantly increased and the subjective caregiving burden significantly decreased in the experimental group as patients' death approached. Heart Rate Variability also indicated a calming effect of the intervention, helping caregivers face patients' death. CONCLUSIONS: The caregiver support intervention can increase caregiver self-efficacy and reduce the subjective caregiving burden. Heart Rate Variability parameters have the potential to be useful for monitoring caregiver burden in facing patients' death.
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Cuidadores/psicologia , Neoplasias/enfermagem , Adulto , Idoso , Estudos de Coortes , Feminino , Hospitais Universitários , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Family caregivers complete caregiving tasks but may not explore their own feelings about their caregiving experience. OBJECTIVES: The objectives of this study were to develop an experience-based caregiving burden scale for caregivers of patients with advanced cancer and to estimate its predictive value for depression. METHODS: The instrument was first systematically constructed on the basis of data obtained from detailed interviews of 12 caregivers. Then, 134 caregivers completed the questionnaire as a field test to estimate the psychometric properties of the developed tool. RESULTS: We achieved a 13-item Caregiver Burden Scale (CBS) with 3 dimensions: health impact, role competence, and resource and growth. The construct validity, criterion-related validity, and internal consistency reliability of the CBS were satisfactory. A CBS score higher than 25.5, or health impact subscale score higher than 10.5, or role performance score higher than 7.5 indicated significant depression and the need for assistance from healthcare providers. CONCLUSION: The CBS has adequate reliability and validity to assess the burden experienced by caregivers of patients with advanced cancer. It was also predictive for significant depression. IMPLICATION FOR PRACTICE: Nurses may use the CBS to provide timely assistance to family caregivers during their caregiving for a patient with advanced-stage cancer.
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Cuidadores/psicologia , Efeitos Psicossociais da Doença , Neoplasias/psicologia , Inquéritos e Questionários , Adulto , Idoso , Cuidadores/estatística & dados numéricos , Depressão/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/patologia , Valor Preditivo dos Testes , Psicometria , Pesquisa Qualitativa , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: Sleep disturbances among family caregivers (FCs) are common in advanced cancer. The comprehensive factors for sleep disturbances among the FCs of patients with cancer have not been investigated in Taiwan. The purposes of this study were to investigate the sleep disturbances among the FCs of patients with advanced cancer and to determine predictors of sleep disturbance. METHODS: A descriptive, cross-sectional study was conducted among 172 FCs. Data were collected using the Pittsburgh Sleep Quality Index and wrist actigraphy. A linear regression model was used to identify the predictive factors for sleep quality. RESULTS: Seventy-six percent of the FCs experienced some sleep disturbances. Female gender, more fatigue, greater depression, more caregiving burden, and spending over 16 h per day on caregiving tasks were risk factors for sleep disturbances in caregivers. CONCLUSIONS: Sleep disturbances were common among the Taiwanese FCs of patients with advanced cancer. FCs with risk factors for sleep disturbances should be identified and provided assistance.
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Cuidadores/psicologia , Neoplasias/psicologia , Neoplasias/terapia , Transtornos do Sono-Vigília/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/patologia , Fatores de Risco , Taiwan/epidemiologia , Adulto JovemRESUMO
The purpose of this study was to evaluate the effects of family-involved care on caregivers' self-efficacy, the degree of satisfaction with central-line care, and the occurrence of central-line-associated bloodstream infections (CLABSIs). We adopted a pretest-posttest quasi-experimental design, recruiting 62 participants from 2009 to 2010. Family caregivers in the experimental group received instructional guidance before collaboratively participating in patient care, whereas the control group received routine care. Our results indicated that in both groups, the overall posttest scores for self-efficacy were significantly higher than the pretest scores. The score for the question "When the patient moves around, how confident are you with ensuring catheter safety?" was significantly higher in the experimental group than in the control group. Satisfaction with the provision of central-line care was also significantly higher in the experimental group than in the control group. CLABSIs did not occur in either group of patients.