Amy L. Govoni

The effect of a Web-based stroke intervention on carers' well-being and survivors' use of healthcare services

Purpose. We hypothesised that carers of stroke survivors who participate in the Web-based intervention, Caring∼Web©, would have higher well-being than non-Web users. We also postulated that those survivors whose carers participated in Caring∼Web would use fewer healthcare services. Method. A randomised, two-group, repeated measures design was used. Subjects were recruited from four rehabilitation centres from which first-time stroke survivors were discharged to home in two Midwestern states. Of 144 carers screened, 103 carers of these survivors who were novice Internet users were assigned to a Web or non-Web user group. Seventy-three subjects completed the study. Intervention. Caring∼Web was a Web-based intervention of education and support provided to the Web user group for 1 year. A bi-monthly telephone survey collected data on all carers well-being (perceived depression, life satisfaction) and survivors healthcare service use (self-reported provider and emergency department visits, hospital re-admissions, nursing home placement). Results. No statistical differences were found between the groups in carers well-being or in the number of provider visits for survivors. There were significant differences in emergency department visits (p = 0.001) and hospital re-admissions (p = 0.0005) related to the health of survivors. Conclusions. This Web-based intervention helped new carers make informed decisions about healthcare needs of stroke survivors, thus reducing service use.

In-home online support for caregivers of survivors of stroke: a feasibility study.

The primary aim of this feasibility study was to determine if caregivers (n = 5) were willing and able to use Caring~Web©, a Web-based intervention for support, from their home Internet connection for 3 months. The caregivers’ perceived health and satisfaction with caring, as well as the care recipients’ use of healthcare services, were recorded. The experience of caring (problems and successes) was examined. Data were collected via weekly online surveys and e-mail discussions. Descriptive analyses revealed that the 3 caregivers who completed the study were satisfied with Caring~Web©. Caregivers rated their health as average to excellent and their satisfaction with caring as good. Care recipients averaged 6 calls/visits to a medical office with one emergency room visit and subsequent hospitalization. Major problems for the caregivers included dealing with medical conditions about which they lacked knowledge. Content analysis of the e-mail discussions revealed that subjects sought information about medical conditions related to caring for the survivor of the stroke. Major successes for the caregivers involved communicating effectively with the care recipient and returning to everyday life with family and friends.

Two Sides to the Caregiving Story

Abstract Purpose: This descriptive study examined problems and successes that a sample of 73 adult caregivers new to the role expressed in the first year of caring for stroke survivors. Data were collected from May 2002 to December 2005. Method: Bimonthly, trained telephone interviewers asked the participants open-ended questions to elicit their experience in caregiving. Guided by Friedemann’s framework of systemic organization, we analyzed the data using Colaizzi’s method of content analysis. Results: There were 2,455 problems and 2,687 successes reported. Three themes emerged from the problems: being frustrated in day-to-day situations (system maintenance in Friedemann’s terms), feeling inadequate and turning to others for help (coherence), and struggling and looking for “normal” in caring (system maintenance vs. change). Three themes were attributed to the successes: making it through and striving for independence (system maintenance), doing things together and seeing accomplishments in the other (coherence), and reaching a new sense of normal and finding balance in life (individuation and system maintenance). Conclusion: These findings provided an in-depth, theorybased description of the experience of being a new caregiver and can help explain how caring can be a difficult yet rewarding experience. Knowledge of the changes over time allows health care professionals to tailor their interventions, understanding, and support.

Caregivers dealing with stroke pull together and feel connected

Changes that can accompany stroke may create considerable stress for individuals caring for the affected person. This study explored the coping process for nine rural-dwelling caregivers of persons with stroke and the responses of these caregivers to a Web-based support program. The qualitative data management program QSR N 5 was used to analyze quotes from telephone interviews and computer entries. Stories of how caregivers came together and supported one another emerged from the data collected as part of a larger study that examined the experience of caring. Friedemanns framework of systemic organization guided data analysis and interpretation. Actions demonstrated by the caregivers illustrated the process of crisis resolution through family togetherness in which nurses were included. The findings of this study aided in understanding this process and gave direction for nurses working with such clients.

Caregivers’ Incongruence: Emotional Strain in Caring For Persons With Stroke

Purpose: Guided by Friedemanns 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 Friedemanns terms, from their viewpoint and provides direction for supportive education interactions.

INTO AGING: EXPLORING AGING THROUGH GAMES

The daily care of long-term patients erodes the morale of the most dedicated caregivers from time to time. This is especially true when patients are old and the obstacles to their independence appear insurmountable. The care of the aged may become synonymous with confusion, incontinence, loneliness, or inevitable dependency. In an effort to help nursing staff explore these attitudes toward the elderly, a gaming technique was incorporated into staff development programming. Extensive experience with the technique has convinced us that it might be a valuable approach for others working with staff caring for the elderly.

Collaborative Research Among Clinical Nurse Specialists and Staff Nurses

BACKGROUND Conducting research in clinical settings can be problematic for many nurses in practice due to lack of experience and support. METHOD Research collaboration between clinical nurse specialists and staff nurses in clinical settings can promote development of their research process skills. RESULTS Strategies identified can be applied by clinical nurse specialists involved in continuing education and staff development in clinical practice through further research development. CONCLUSION Collaboration among clinical nurse specialists and staff nurses provides a unique and strong link that transcends degrees and roles to make substantial contributions to professional nursing practice.