Caregiving experiences of family members of persons with dementia in south India.

This study reports on the first phase of an investigation aimed at adapting The Savvy Caregiver program, a successful family caregiving curriculum developed in the United States, for application in South India. Thirty family members caring for a person with dementia were interviewed regarding their experiences as caregivers (CGs). Qualitative interviews were conducted with the family member at a geriatric clinic, while other diagnostic procedures were being carried out with the person with dementia. Findings from the study revealed that although family members understood the term CG, none could identify a word for CG in his or her language. There was little understanding of dementia as an illness. Family CGs reported feeling distressed, overwhelmed, and frustrated with caregiving. Caregivers were interested in an educational program, but many had unrealistic expectations for what they wanted to learn. The findings provide directions for adapting The Savvy Caregiver curriculum for Indian family CGs.

Advanced practice nurse psychiatric bridging intervention.

Depression is a prevalent and treatable condition; however, extensive waiting periods for treatment are associated with high failure to attend initial psychiatric evaluation (IPE) appointments. This article describes the development, implementation, and pilot evaluation of the Advanced Practice Nurse (APN) Psychiatric Bridging Intervention. The project was grounded in Peplau's theory of interpersonal relations and designed to provide supportive psychoeducational counseling and initiation of psychotropic medication for clients with depressive symptoms during the time between intake and IPE. Project development was guided by Roger's Diffusion of Innovations framework used for adopting an evidence-based innovation into an organization. A two-group design allowed comparison of preintervention clients (38 clients who received standard care) and intervention clients (19 clients who participated in the bridging intervention). The difference in IPE appointment attendance rates between the two groups approached statistical significance (p = 0.08). An unanticipated finding was that APN Psychiatric Bridging Intervention clients required only 30-minute IPE appointments compared to the typical 60-minute appointment.

An innovative approach to diabetes education for a Hispanic population utilizing community health workers.

Type 2 diabetes disproportionately affects the Hispanic population. New approaches are needed to provide effective education to this population. This evidence-based project utilized community health workers (CHWs) to deliver a culturally relevant diabetes education program to a Hispanic population at a migrant clinic. The program emphasized culturally relevant interventions to improve self-efficacy. Formative evaluation was used to develop and improve the program. Participants showed improvement in diabetes knowledge and diabetes related self-efficacy scores. Outcomes also included improvement in CHWs' diabetes knowledge and development of an educational program that could be utilized in other settings serving Hispanic populations with type 2 diabetes.

Relationship matters in dementia caregiving.

This study examined the relationship between four framing categories of caregiving (Relational, Instrumental, Reactive, Role Acquiring), derived from interviews with spouse caregivers, and scores on standardized measures of responses to and outcomes of caregiving. Participants were 132 spouses recruited into a larger intervention study of family caregivers of community-dwelling persons with dementia. Qualitative data were analyzed using constant comparative method; quantitative data were analyzed using one-way analysis of variance (ANOVA). Findings demonstrated that relational spouses scored better than spouses in the other three categories, indicating greater positive well-being. Relational spouses also scored significantly lower than instrumental and reactive spouses on a composite caregiver distress measure (p = 0. 003). These results suggest that interventions may need to be tailored to spouses with different caregiving perspectives.

Decision analysis as a tool to support an analytical pattern-of-reasoning.

Decision analysis is offered as a tool to aid nurses' decision-making in complex and troublesome situations where there are mutually exclusive actions and time is available for deliberation. Decision analysis can be formal or informal. Formal decision analysis provides a structure for representing the decision situation and a mathematical procedure for prescribing the alternative action that is most consistent with what is known and what one values. Informal decision analysis uses the concepts and sometimes the structure of decision analysis, but usually does not include the mathematical calculations. In the present paper, the authors illustrate how formal and informal decision analysis might be used by nurses to: (i) enhance their own decision-making; (ii) assist patients or family caregivers with decision-making and; (iii) promote informed health care policy development. Finally, the advantages and limitations of decision analysis are discussed.

Discourse-derived perspectives: differentiating among spouses' experiences of caregiving.

A method of constant comparative analysis was used to code open-ended interviews with 132 spouse caregivers regarding their experiences in caregiving. Results of this analysis yielded 69 qualitative code categories. We used these categories to compare the caregivers on several groupings that the literature has identified as providing meaningful ways to differentiate among caregivers. We used the qualitative responses to compare the caregivers by caregiver gender care-recipient dementia severity, and duration of caregiving. Results partly confirmed previous findings that wife caregivers are more distressed than husbands, but the results also indicated these caregivers were more similar than dissimilar The other analyses likewise indicated greater similarities than dissimilarities in the caregiving experience. We next continued the analysis and, using the coding categories as a springboard, identified four distinct patterns for construction of the meaning of the caregiving experience in the caregivers' discourse. These discourse-derived framing categories, applicable in about three-quarters of the caregivers, offered other ways to distinguish among caregivers. Further analysis of these robust groupings' showed important differences among the groups. These framing categories suggest ways to differentiate among caregivers, based on their perception of their role in the caregiving situation, ways that might point the way to intervention strategies for each of the groupings.