[Home care in a culturally sensitive environment: perspectives of caregivers of Haitian elderly patients and relatives]. / Des services à domicile culturellement sensibles: perspective des intervenants et des proches-aidantes originaires d'Haïti en tant que cas traceur.

In Canada, the care provided by families occurs in an increasingly multiethnic context. Against this backdrop, the present qualitative study aims to explore the needs/expectations and solutions not only of (female) natural caregivers of an elderly relative hailing from Haiti (presented in terms of tracking cases) but also of remunerated home care providers - all with a view to developing a culturally sensitive service offering. As such, this study works from a conceptual framework centring on the negotiation of a common area of agreement between the stakeholders involved (i.e., natural caregivers and home care providers). To this end, focus groups and individual interviews were conducted among 15 caregivers and 37 home care providers. The three recurrent themes emerging from the data analysis concern, in context, the needs/expectations and solutions surrounding the experience of service use, barriers to use, and the relationships between natural caregivers and home care providers. The statements of both groups evidenced a consistency of views and have thus provided a basis for developing some recommendations acceptable to all stakeholders from the perspective of making culturally-based adjustments to the service offering.

Implementation and effects of an individual stress management intervention for family caregivers of an elderly relative living at home: a mixed research design.

The purpose of this project was to evaluate the implementation and effects of a stress management intervention for family caregivers of elderly persons. The intervention was implemented through an action research design with the collaboration of case managers working in community health centers. A total of 81 caregivers participated in the study. The quasi-experimental design used to test the effects of the intervention showed significant effects on perceived challenge associated with caregiver role, control by self, use of social support, and use of problem solving. Qualitative data demonstrate caregiver empowerment with respect to the caregiving role. This study illustrates the relevance of using a mixed research design in order to provide evidence for changes in practice.

[Ambulatory turning point and family home care: a gamble in public health]. / Virage ambulatoire et soins familiaux à domicile: un enjeu de santé publique.

CONTEXT: Family caregivers are now considered an at-risk population in Canada. As hospital stays have been gradually reduced, family caregivers of the elderly are burdened with complex responsibilities. This change in care delivery was implemented with little consideration for services offered to this specific population. INTERVENTION AND DISCUSSION: The purpose of this study was to explore the perceptions of four groups of stakeholders towards services as determinants of health: family caregivers, professionals, community organizations and health care administrators. Focus groups (FG) were conducted (n=11 with 49 participants), followed by semi-structured interviews with key informants (n=29), in urban and rural areas. Results of content analysis were categorized according to the Donabedian model. Congruent perceptions between groups pinpointed the following: A limited accessibility of services, a lack of flexibility and coordination of services, a disregard for health promotion of caregivers and a lack of preventive services. Transportation problems and geographical distance to access services were specific to rural area. CONCLUSION: Results provide evidence-based data for public health. They suggest insights for the development of preventive interventions and services for this increasing at-risk population of family caregivers in Canada.

Qualitative evaluation of a stress management intervention for elderly caregivers at home: a constructivist approach.

The purpose of this project was to evaluate, using a constructivist qualitative design, an individual stress management intervention based on a stress-coping model and intended for family caregivers of elderly persons within the current context of the shift to ambulatory care. This nursing intervention comprised seven weekly encounters with caregivers following their elderly family member's discharge from hospital and a follow-up visit one month after. The aim of the qualitative evaluation was to document the feasibility and acceptability of the content of the intervention, its relevance in terms of process and structure, and the benefits to the principal stakeholders. This action research project was a case study of four participants. The assessment instruments included an intervention analysis grid, a diary, and a semistructured interview guide with the participants. Data analysis drew on Guba and Lincoln's (1989) method which made it possible to refine the intervention. Results underscored that certain implementation conditions must be respected in order to ensure the intervention's acceptability and feasibility. Above all, it must remain flexible and the nurse must possess the requisite clinical skills and theoretical knowledge. It is important also to screen judiciously for caregivers likely to benefit from the intervention. The pertinence of using a circular intervention model rather than a linear approach to stress management was highlighted as well.