Alain Legault

“Learning to Become a Family Caregiver” Efficacy of an Intervention Program for Caregivers Following Diagnosis of Dementia in a Relative

PURPOSE The purpose of this experimental study was to test the efficacy of a psychoeducational individual program conceived to facilitate transition to the caregiver role following diagnosis of Alzheimer disease in a relative. DESIGN AND METHODS Caregivers were recruited in memory clinics and randomized to an experimental group (n = 62) or a control group (n = 49) receiving usual care. Eligible participants-primary caregivers of a relative diagnosed with Alzheimer in the past 9 months-were assessed blindly before randomization, at the end of the program (post-test), and 3 months later (follow-up) on different outcomes associated with healthy role transition. RESULTS The analyses indicated that at post-test and follow-up, caregivers in the experimental group were more confident in dealing with caregiving situations, perceived themselves to be better prepared to provide care and more efficacious in their caregiver role, were better able to plan for the future care needs of their relative, had better knowledge of available services, and made more frequent use of the coping strategies of problem solving and reframing. The program had no significant effect on use of stress-management strategies, perceived informal support and family conflicts. IMPLICATIONS This program underscores that a proactive intervention approach from the onset of the care trajectory is key to fostering caregiver adaptation to the new challenges they must meet.

Development of an Intervention Program for Alzheimer's Family Caregivers Following Diagnostic Disclosure:

The purpose of this qualitative study was to develop a pro-active psycho-educational intervention program for Alzheimers family caregivers following diagnostic disclosure. Based on a theoretical model of role transitions and a participatory approach, the study comprised four steps: (a) exploring caregiver needs; (b) developing and validating a program proposal based on caregiver-expressed needs; (c) formalizing program through intervention mapping; and (d) testing and qualitatively evaluating the program. The psycho-educational program consisted of seven individual sessions aimed at fostering knowledge and skills required to ensure successful transition to the caregiver role. The approach used in this study can serve as a guide for the development of nursing intervention programs. Intervention mapping allowed, in particular, integrating theoretical and empirical elements in a formal intervention model.

‘Taking Care of Myself’ Efficacy of an intervention programme for caregivers of a relative with dementia living in a long-term care setting

The purpose of this randomized study was to test the efficacy of an intervention programme entitled ‘Taking Care of Myself’ on selected indicators of mental health of daughter caregivers of elderly parents with dementia living in a long-term care setting. The programme is based on an empowerment perspective and on a stress and coping theoretical framework. Three groups of caregivers were compared: one took part in the experimental programme (EG, N= 45), one in a comparison programme offered by a Quebec Alzheimer Society (AG, N = 51), and another was a control group (CG, N = 41). Two successful outcomes are unique to the EG condition, that is, competence dealing with health care staff and perceived challenge of the caregiver role. Prediction analyses also provide statistical support for the efficacy of the EG and AG conditions to produce successful outcomes with respect to common indicators (perceived threat and role overload, control by self, informal/formal social support, and use of the coping strategy of reframing). These results provide avenues of intervention for promoting the mental health of caregivers of an institutionalized relative.

Development Process and Qualitative Evaluation of a Program to Promote the Mental Health of Family Caregivers

The purpose of this study was to develop and evaluate, through a participatory approach, an intervention program to promote the mental health of women caregivers in institutions. Focus groups were first organized to explore sources of stress for daughter and spousal caregivers. Workshops in which caregivers developed the content of a group program were then organized. The aims of the program were to increase empowerment and self-efficacy and to decrease stress and psychological distress of caregivers. Experimentation and qualitative evaluation of the program led to 10 weekly meetings covering the following topics: how to feel good with my relative, how to discuss with staff, how to appraise my experience differently, coping with my relatives losses, how to reorganize my life, and how to identify and ask for social support. This study provides a structured program to support family caregivers and a research method empowering families.

Ethical competence: An integrative review.

Background: Ethics, being a fundamental component of nursing practice, must be integrated in the nursing education curriculum. Even though different bodies are promoting ethics and nursing researchers have already carried out work as regards this concept, it still remains difficult to clearly identify the components of this competence. Objective: This integrative review intends to clarify this point in addition to better defining ethical competence in the context of nursing practice. Method: An integrative review was carried out, for the 2009–2014 period, in the CINAHL, MEDLINE, and EMBASE databases and in the journal Nursing Ethics. The keywords nursing ethics or ethical competence were used in order to make sure to widely encompass the concept of “ethical competence” in the case of a university curriculum in nursing. In the end, 89 articles were selected. Ethical consideration: We have respected the ethical requirements required regarding the sources and authorship. There is no conflict of interest in this literature review. Results: Ethical sensitivity, Ethical knowledge, Ethical reflection, Ethical decision-making, Ethical action, and Ethical behavior are the most frequently used terms with regard to ethical competence in nursing. They were then defined so as to better ascertain the possible components of ethical competence in nursing. Conclusion: Even though ethical competence represents a sine qua non competence in nursing practice, no consensus can be found in literature with respect to its definition. The identification of its components and their relationships resulting from this integrative review adds to the clarification of its definition. It paves the way for other studies that will contribute to a better understanding of its development, especially among nursing students and practicing nurses, as well as the factors that may exert an influence. More adapted education strategies can thus be put forward to support its development.

Introduction of a palliative approach in the care trajectory among people living with advanced MS: perceptions of home-based health professionals

BACKGROUND Even with the desire of home-based health professionals to provide supportive care, the palliative needs of people living with multiple sclerosis (MS) remain unmet. AIM To describe the perceptions of home-based health professionals concerning the introduction of a palliative care approach in the care trajectory of people living with advanced MS. METHOD Based on an exploratory qualitative design, focus groups and individual interviews were conducted with nurses, occupational therapists and social workers (n=13 professionals). RESULTS A palliative care approach was described as a possibility for opening the discussion between the patient and their caregivers about their needs and desires at the end of life. The approach required professionals to be supportive and to adapt their interventions to people living with MS. However, professionals reported difficulties in introducing a palliative care approach. CONCLUSION Health professionals reported that they feel a palliative care approach for people living with MS is mandatory; however, they do not feel comfortable integrating it systematically into their care.

Description des conceptions de la spiritualité et des perceptions du rôle de l’infirmière chez les étudiantes en sciences infirmières quant à la prise en compte de la dimension spirituelle du patient

In North American society people have diverse cultural and religious affiliations. The nursing profession underlines the importance of including patients’ spirituality in giving holistic care. However, studies suggest that the majority of nurses do not include the spiritual dimension on a regular basis. Therefore, we thought it important to focus on undergraduate nurses’ understanding of spirituality as well as on their perception of the nurse’s role in this area. We conducted a quantitative and descriptive cross-sectional study, which gave us an overall view of the students’ perceptions. Three hundred and forty-five students answered an online survey which included French translations of the Spirituality and Spiritual Care Rating Scale and the Students Survey of Spiritual Care. Analysis of the results indicated that the students’ perception of spirituality is a contemporary one. The majority agree that nurses should include spirituality in their care but do not feel equipped to do so adequately. A comparative analysis showed that the students’ answers differed significantly depending on their cultural affiliation as well as on their affiliation or not with a religion. Recommendations for teaching purposes will also be presented.

Fathers’ Experience After the Death of Their Child (Aged 1–17 Years):

The death of a child is traumatic for parents. The grief of bereaved fathers is inadequately understood since most studies on this subject have focused primarily on mothers. The goal of this phenomenological study was to understand fathers’ experiences following the death of their child. Interviews were conducted with 13 fathers whose child (aged 1–17 years) had died at least 1 and up to 6 years earlier, either from a life-limiting illness or unexpectedly in an intensive care unit in a pediatric hospital in Eastern Canada. The analysis indicates that fathers’ experience deep suffering after the death of their child and feel torn between the past and the future. Three major themes were identified: needing to push forward in order to avoid breakdown, keeping the child present in everyday life, and finding meaning in their experience of grief. Clinical implications for professionals working with this population are discussed.