Male Caregivers' Stories: How They Successfully Adjust to Partners With Stroke.

Men transitioning from noncaregiver to caregiver for their partner (wife or long-term friend) with stroke may find that role unsettling. Male caregivers' success stories in caring for these partners through authors' reflections from their experience are shared. These men's stories focused on achievements: (1) gaining confidence through functional improvement; (2) nurturing success through mutually positive attitude; and (3) resuming "normal" roles. Providers can learn from these accounts, sharing these success stories with other caregivers so that they can successfully adapt to new roles in caring for women partners with stroke.

"It makes me feel like good inside because I helped him do stuff" - Perceptions of psychological well-being in adolescents providing dementia care.

According to a 2018 report by the Alzheimer's Association, an estimated 250,000 children help support a family member with dementia, but few studies exist that describe their experience as family carers. This qualitative descriptive study sought to understand the perceived psychological well-being of adolescents who assist with providing care to family members with dementia. Eleven adolescents ages 12 to 17 caring for older non-parental family members with dementia in northwest Ohio participated in one of three focus group discussions. An adult family member was surveyed about family background and level of assistance provided. The data from the two questionnaires were analyzed using descriptive statistics. Focus group transcripts were analyzed using thematic content analysis. Thematic analysis revealed six themes related to psychological well-being: 1) Feeling compassion for the family member; 2) Finding connection through fun, humor, and mutual affection; 3) Helping even though it is not always pleasant; 4) Feeling good inside about helping family "do stuff"; 5) Believing no one can do it like family; and 6) Reflecting that it is just something that they do. The findings of this study provide new insight into adolescents' experiences of dementia family care and how it affects their psychological well-being. An examination of the themes suggests that secondary caring roles were mostly positive in nature and may help adolescents forge closer family relationships, find opportunities for personal growth and development, and overcome challenges to grow more confident. These findings may also suggest ways to include adolescents in family care as a means of positive growth opportunities.

State Tested Nursing Assistants' Workplace Experiences That Threaten or Support Intent to Stay.

PURPOSE: Over 1 million Americans utilize skilled nursing facilities (SNFs) annually. Within SNFs, State Tested Nursing Assistants (STNAs) are primary caregivers; however, low retention rates are notable and threaten patient care. DESIGN: A phenomenological, qualitative study was conducted to explore intrinsic factors that influence STNAs' intent to stay in their positions. METHODS: Ten STNAs employed at for-profit SNFs participated in semistructured face-to-face interviews. Data were analyzed to identify broad concepts and recurrent themes. FINDINGS: Findings suggest that intrinsic factors supporting and threatening intent to stay included the fulfillment of basic psychological needs. Supporting themes included self-confidence, appreciation, positive relationships, and a willingness to go beyond required duties. Threatening themes included frustration, lack of support, and career advancement opportunities. CONCLUSIONS: Findings provide an understanding of factors that influence STNAs' intent to stay. CLINICAL RELEVANCE: The results may help guide the development of responsive strategies that improve quality and continuity of care in SNFs.

Nursing Home Staff's Perceptions of Noise Compared to Measured Noise Levels: A Descriptive Study.

A noisy environment may cause annoyance to nursing home staff and affect their ability to provide quality care to residents. The current descriptive study examined differences between staff's perceived noise levels and measured noise levels in four nursing home facilities in Ohio. Most participants (N = 90) were White females. Consistent with measured noise levels, participants described all facilities as being moderately noisy. The loudest perceived noise sources included door/patient alarms and floor cleaners, which were confirmed by measured noise levels. Inconsistent with measured noise levels, most participants identified the nurses' station as one of the noisiest locations. Overall, participants at all facilities were neutral or disagreed that noise levels impacted themselves or residents. However, nursing home staff should be educated about how they contribute to noise levels and the potential effects of noise on work performance and quality of care provided to residents. [Journal of Gerontological Nursing, 46(9), 37-45.].

Perceptions of Water-related Environmental Concerns in Northwest Ohio One Year after a Lake Erie Harmful Algal Bloom.

Water is essential to human life around the world, but there are numerous threats to its quality both internationally and nationally. The purpose of this secondary data analysis was to examine public perceptions of water-related environmental concerns in northwest Ohio. In fall 2015, nine focus groups on environmental health conditions were conducted with Lucas County, Ohio residents. Each 90-min focus group was videotaped and professionally transcribed to maximize data capture and facilitate data analysis. Colaizzi's (1978) method of content analysis was applied to make sense of the participants' environmental concerns related to water. The majority of the 93 participants were white females between the ages of 40 and 59. A do-not-drink advisory related to a harmful algal bloom in the summer of 2014 and the possibility of a future bloom were still prominent in residents' minds that affected their perceptions and behaviors 1 year later. The emergent themes included: (1) avoiding the use of tap water due to concerns about water quality, (2) mourning the loss of a precious resource and their childhood recreational activities, (3) believing there are financial impacts associated with water problems, (4) distrusting the actions and decisions of persons in authority, (5) wanting to stop fighting about who is to blame and determine the problem's real cause, and (6) desiring actions and planning by authorities to prevent future problems. Understanding public perceptions of water-related environmental concerns can inform practitioners worldwide on successful approaches to restoring trust, educating about and communicating risk, and planning for future issues.

Male Caregivers Report Problems in Caring at Home After Spouses Survive Stroke.

STROKE is sudden and often traumatic with results that affect both the patient and family members who provide care. Approximately 40% of individuals caring for family members/friends are male. Transitioning from the noncaregiver role to caregiver can be unsettling. Guided by Friedemann's framework of systemic organization, this secondary data analysis examined problems reported by men caring for spouses in the first year after stroke. Using a mixed methods design, 73 caregivers (CGs) participated in bimonthly telephone interviews for 1 year. For this analysis, only the males caring for spouses (n = 12 married and n = 1 unmarried partner) were examined. These data were analyzed using Colaizzi's rigorous method of content analysis. Five problem themes emerged: 1) adjusting to multitasking in everyday living (Friedemann's system maintenance and individuation), 2) recognizing physical and mental disabilities (coherence), 3) dealing with outside forces and limited resources (individuation), 4) struggling to return to normal (system maintenance), and 5) feeling physically, mentally, and emotionally exhausted (system maintenance). These problem themes demonstrated incongruence as the men sought to maintain their prior lives.Theory-based themes of male stroke CGs' problems were uncovered that can be used to target interventions to help them achieve balance between incongruence and congruence in their lives.

Family caregivers' reports of hospitalizations and emergency department visits in community-dwelling individuals with dementia.

Individuals with dementia in the United States have higher rates of hospitalizations and emergency department visits compared to those without. This descriptive study examined the frequency of hospitalizations and emergency department visits among community-dwelling individuals with dementia, reasons for hospitalizations and emergency department visits, and caregivers' actions to prevent these events. Family caregivers ( n = 63) from education/support groups offered through Alzheimer's Association chapters in western Ohio completed a survey. Twenty-two percent of caregivers reported that their care recipient stayed overnight in the hospital and 30% reported that their care recipient visited the emergency department at least once in the past three months. The most frequent reasons for hospitalization and emergency department visits, such as urinary tract infections and fall-related injuries, were potentially avoidable. Caregivers reported giving medications, seeking healthcare services, and obtaining home care services, as the most frequently used preventive actions. Family caregivers of individuals with dementia should be provided substantive education about preventable hospitalizations and emergency department visits.

Meanings of Falls and Prevention of Falls According to Rehabilitation Nurses: A Qualitative Descriptive Study.

PURPOSE: Guided by Friedemann's theoretical framework, this survey explored the meaning of a fall of an institutionalized older adult or fall prevention to rehabilitation registered nurses and whether the experience changed the nurse's practice. DESIGN: Qualitative, descriptive survey. METHODS: A convenience sample of 742 rehabilitation nurses was asked to describe these experiences and the impact on their practice. FINDINGS: Themes discovered related to the meaning of a fall include negative feelings (incongruence) and positive feelings (congruence). Themes related to the meaning of preventing a fall include positive feelings (congruence). Practice change themes emerged from both the experience of a fall and fall prevention. Practice change themes were drawn to Friedemann's (1995) process dimensions. CONCLUSIONS AND CLINICAL RELEVANCE: Nurses' experiences and meanings of falls uncovered negative and positive feelings about these falls. New findings of this study were the positive feelings expressed by nurses, when there was no injury or when a fall was prevented.

Information Needs of Family Caregivers of People With Dementia.

PURPOSE: Understanding caregiver needs is essential when caring for people with dementia. The aim of this study was to identify family caregivers' information needs as perceived by home care workers and the caregivers themselves. DESIGN: This study used a descriptive survey design and convenience sampling. METHODS: The two groups of care providers were given a list of 48 items and asked to choose caregivers' top 10 information needs. FINDINGS: Group 1 (n = 33 unpaid family caregivers) identified dealing with behavior changes and group 2 (n = 59 paid home care workers) identified providing personal care as most important. CONCLUSION: While differences between these groups emerged, both care providers chose more items related to needing help for the care recipient, than items related to needing help for the caregivers themselves, e.g., support group. CLINICAL RELEVANCE: These information needs can be used by rehabilitation nurses and other healthcare professionals to develop educational materials and supportive interventions.

Qualitative analysis of a nurse's responses to stroke caregivers on a web-based supportive intervention.

BACKGROUND: Approximately 800 000 people experience a stroke every year; most are cared for by unpaid family members in home settings. Web-based interventions provide 24/7 access to education/support services and have been explored in the literature with family caregivers dealing with chronic conditions. Current research into nurses' web-based interactions with caregivers in these interventions is lacking. OBJECTIVE: The aim of this qualitative secondary data analysis was to examine a nurse specialist's responses and advice that she gave in a web-based supportive intervention for stroke family caregivers used in a randomized controlled trial for 1 year. METHODS: Using a qualitative research design, caregivers were recruited from rehabilitation facilities in Ohio and Michigan (n = 36). They accessed the intervention's email forum and discussion group facilitated by the nurse. These email message data were examined using rigorous content analysis. RESULTS: The caregivers were primarily white women caring for a spouse, with an average age of 54 years. From the 2148 email messages between the nurse and caregivers, five themes emerged and were drawn to Friedemann's Framework. These themes included: getting to know the situation (Friedemann's coherence and individuation), validating emotions (individuation), promoting self-care (individuation), assisting in role adaptation (system maintenance and individuation), and providing healthcare information (system maintenance and individuation). CONCLUSIONS: These caregivers of stroke survivors were asking for advice, seeking support, and looking for information from an advanced practice nurse. Nurses, and others, in supportive roles can use these findings to promote informed care and directed interventions for caregivers dealing with stroke and its outcomes.

Web-based psychosocial assessment for caregivers of persons with dementia: a feasibility study.

PURPOSE AND DESIGN: Most of the 5.4 million Americans with dementia are cared for by family members who experience care needs and time constraints. This quasi-experimental study examined the experience of using a psychosocial assessment instrument to understand caregiver needs delivered in an interview versus a self-administered web-based format. METHODS: Ten family caregivers were randomized to an interview group or a web-based group with two advanced practice registered nurses (APRNs). Surveys captured the caregivers' and APRNs' assessment experiences. FINDINGS: There were no statistically significant differences between the two caregiver groups. Both groups rated the assessment instrument as excellent or good, finding it easy to complete capturing real needs they frequently denied or ignored. The APRN reported the web-based format was easier to use. CONCLUSION AND CLINICAL RELEVANCE: Healthcare providers could use web-based caregiver assessment as an effective, efficient method for identifying care needs and planning interventions that promote balance/congruence in caregivers' lives.

Linking theory with qualitative research through study of stroke caregiving families.

PURPOSE: This theoretical article outlines the deliberate process of applying a qualitative data analysis method rooted in Friedemann's Framework of Systemic Organization through the study of a web-based education and support intervention for stroke caregiving families. METHODS: Directed by Friedemann's framework, the analytic method involved developing, refining, and using a coding rubric to explore interactive patterns between caregivers and care recipients from this 3-month feasibility study using this education and support intervention. Specifically, data were gathered from the intervention's web-based discussion component between caregivers and the nurse specialist, as well as from telephone caregiver interviews. FINDINGS AND CONCLUSIONS: A theoretical framework guided the process of developing and refining this coding rubric for the purpose of organizing data; but, more importantly, guided the investigators' thought processes, allowing them to extract rich information from the data set, as well as synthesize this information to generate a broad understanding of the caring situation.

Usage and design evaluation by family caregivers of a stroke intervention web site.

BACKGROUND: Four of five families are affected by stroke. Many caregivers access the Internet and gather healthcare information from Web-based sources. DESIGN: The purpose of this descriptive evaluation was to assess the usage and design of the Caring∼Web site, which provides education/support for family caregivers of persons with stroke residing in home settings. SAMPLE AND SETTING: Thirty-six caregivers from two Midwest states accessed this intervention in a 1-year study. The average participant was 54 years old, White, woman, and the spouse of the care recipient. METHODS: In a telephone interview, four Web site questions were asked twice a month/bimonthly, and a 33-item survey at the conclusion of the study evaluated the Web site usage and design of its components. Descriptive analysis methods were used, and statistics were collected on the number of visits to the Web site. RESULTS: On average, participants logged on to the Web site 1-2 hours per week, although usage declined after several months for some participants. Participants positively rated the Web site's appearance and usability that included finding the training to be adequate. CONCLUSION: Web site designers can replicate this intervention for other health conditions.

Caregivers' incongruence: emotional strain in caring for persons with stroke.

PURPOSE: Guided by Friedemann's framework, the purpose of this study was to examine the dimensions of new family caregivers' emotional strain in caring for persons with stroke. METHOD: Seventy-three caregivers who were new to that role participated in an interview every 2 weeks for a year as part of a NIH project. Of these caregivers, 36 participants were randomly assigned and had access to a Web-based intervention and its e-mail discussion. In this secondary data analysis, 2,148 e-mail discussion messages plus 2,455 narrative interview entries were used to examine dimensions of caregivers' emotional strain. Rigorous content analysis was applied to these data. RESULTS: The majority of these caregivers were white women with an average of 55 years who cared for spouses. Three themes emerged from these data: (1) being worried, (2) running on empty, and (3) losing self. DISCUSSION: Caregivers worried about themselves and their care recipient, sharing feelings of being just "plain tired." The caregivers felt that their lives were lost to giving care. They described in detail the emotional strain that they felt, as they took on new roles in caring for the person with stroke. CONCLUSION: This study informs nurses about new family caregivers' emotional strain, or incongruence in Friedemann's terms, from their viewpoint and provides direction for supportive education interactions.

Information needs of family caregivers of persons with cognitive versus physical deficits.

This study compared information needs of caregivers of persons with dementia with caregivers of those who received rehabilitation treatment. Caregivers were provided a 48-item survey and asked to choose their top ten information needs. Dementia caregivers' (n = 33) top needs were dealing with forgetfulness/confusion (91%) and repeating questions/actions (61%) in care recipients. Rehabilitation caregivers' (n = 40) top needs were handling care recipients' mobility problems (75%) and dealing with their own stress (65%). Dementia caregivers focused on care recipients' needs related to behavioral symptoms, whereas rehabilitation caregivers focused on needs related to physical care of care recipients and their own needs.

Stroke caregivers share ABCs of caring.

New stroke caregivers (N = 36) participated in a Web-based intervention that provided support and education and included exchanging e-mail messages in a discussion group. A male spousal caregiver posted a poem in his final message at the end of 1 year of participation in this discussion group. He used each letter of the alphabet to choose a word that represented a theme for what he had discovered while caring for his wife. A secondary analysis project examined narrative data from all caregivers' e-mails to see whether support existed for the word themes in the ABCs poem. 2,148 e-mails were read and examined using content analysis to get a sense of the meaning of the content, and then key words were identified that matched each of the poem's word themes. Other caregivers' e-mail examples verified all 26 word themes of the ABCs poem. Nurses can use these themes when providing education and support interventions to stroke caregivers new to their new role.

Caregivers' experience: bimonthly participation in a year-long research interview process.

New caregivers of stroke survivors participated in a bimonthly research interview process for a year-long intervention study. The purpose of this current project was to describe the telephone interview experience for those in the study's control group. We purposively selected 14 participants to answer a telephone survey. The following themes emerged: (a) looking forward to talking with someone, (b) feeling helped and staying connected, (c) being busy caregiving and taking care of business, (d) helping others, and (e) being ambivalent or negative about the interview process. Orem's self-care deficit nursing theory was then applied to reflect upon these themes. It is important for nurse researchers to remember that interviews used for data collection are not neutral or noninteractive.