Carolina Baltar Day

Nursing home care educational intervention for family caregivers of older adults post stroke (SHARE): study protocol for a randomised trial

BackgroundFamily caregivers of aged stroke survivors face challenging difficulties such as the lack of support and the knowledge and skills to practice home care. These aspects negatively influence the caregivers’ burden and quality of life, the use of health services, and hospital readmissions of the stroke survivor. The aim of this research is to describe an educational intervention focused on family caregivers of stroke survivors for the development of home care in the south of Brazil.MethodsA randomized clinical trial with 48 family caregivers of stroke survivors will be recruited and divided into two groups: 24 in the intervention group and 24 in the control group. The intervention will consist of the systematic follow-up by nurses who will perform three home visits over a period of 1 month. The control group will not receive the visits and will have the usual care guidelines of the health services. Primary outcomes: burden and quality of life of the caregiver. Secondary outcomes: functional capacity and readmissions of the stroke survivors; the use of health services of the stroke survivors and their family caregivers. Outcomes will be measured 2 months after discharge. The project was approved in April 2016.DiscussionThis research offers information for conducting educational intervention with family caregivers of stroke survivors, presenting knowledge so that nurses can structure and plan the actions aimed at the education of the family caregiver. It is expected that the educational intervention will contribute to reducing caregiver burden and improving their quality of life, as well as avoiding readmissions and inadequate use of health services by stroke survivors.Trial registrationClinicalTrials.gov, ID: NCT02807012. Registered on 3 June 2016. Name: Nursing Home Care Intervention Post Stroke (SHARE).

Associação entre responsabilidade filial no cuidado aos pais e sobrecarga dos cuidadores

Objective: To analyze the association between filial responsibility and the overload of the children when caring for their older parents. Method: Cross-sectional study with 100 caregiver children of older adults. Filial liability was assessed by the attitudes of the responsible child (scale of expectation and filial duty) and by care behaviors (assistance in activities of daily living, emotional and financial support, and keeping company). The overload was assessed by the Caregiver Burden Inventory. To assess the associations, the correlation coefficients of Pearson and Spearman, Kruskal-Wallis Test, and Mann-Whitney were employed. Variables that presented p-value<0.20 in the bivariate analysis were inserted in a multivariate linear regression model. Results: The factors associated with overload were: formal employment (p=0.002), feelings regarding family life (p<0.001), financial support (p=0.027), and assistance with Activities of Daily Living (ADLs) (p<0.001). Conclusion: Children who were more involved with the ADLs and provided financial support showed higher levels of overload. Objetivo: Analisar a associação entre a responsabilidade filial e a sobrecarga dos filhos cuidadores de pessoas idosas. Método: Estudo transversal com 100 filhos cuidadores de pessoas idosas. A responsabilidade filial foi avaliada pelas atitudes de responsabilidade filial (escala de expectativa e dever filial) e pelos comportamentos de cuidar (auxílio nas atividades de vida diária, apoio emocional, financeiro e companhia). A sobrecarga foi avaliada pelo Inventário de Sobrecarga do Cuidador. Para avaliar as associações utilizaram-se os coeficientes de correlação de Pearson e Spearman, Teste de Kruskal-Wallis e Mann-whitney. Variáveis que apresentaram valor de p<0,20 na análise bivariada foram inseridas em um modelo multivariado de regressão linear. Resultados: Os fatores associados com a sobrecarga foram: emprego formal (p=0,002), sentimentos na vida familiar (p<0,001), apoio financeiro (p=0,027) e ajuda nas Atividades da Vida Diária (AVDs) (p<0,001). Conclusão: Os filhos que mais auxiliavam nas AVDs e prestavam apoio financeiro apresentaram maiores níveis de sobrecarga.Objective: To analyze the association between filial responsibility and the overload of the children when caring for their older parents. Method: Cross-sectional study with 100 caregiver children of older adults. Filial liability was assessed by the attitudes of the responsible child (scale of expectation and filial duty) and by care behaviors (assistance in activities of daily living, emotional and financial support, and keeping company). The overload was assessed by the Caregiver Burden Inventory. To assess the associations, the correlation coefficients of Pearson and Spearman, Kruskal-Wallis Test, and Mann-Whitney were employed. Variables that presented p-value<0.20 in the bivariate analysis were inserted in a multivariate linear regression model. Results: The factors associated with overload were: formal employment (p=0.002), feelings regarding family life (p<0.001), financial support (p=0.027), and assistance with Activities of Daily Living (ADLs) (p<0.001). Conclusion: Children who were more involved with the ADLs and provided financial support showed higher levels of overload. Objetivo: Analisar a associacao entre a responsabilidade filial e a sobrecarga dos filhos cuidadores de pessoas idosas. Metodo: Estudo transversal com 100 filhos cuidadores de pessoas idosas. A responsabilidade filial foi avaliada pelas atitudes de responsabilidade filial (escala de expectativa e dever filial) e pelos comportamentos de cuidar (auxilio nas atividades de vida diaria, apoio emocional, financeiro e companhia). A sobrecarga foi avaliada pelo Inventario de Sobrecarga do Cuidador. Para avaliar as associacoes utilizaram-se os coeficientes de correlacao de Pearson e Spearman, Teste de Kruskal-Wallis e Mann-whitney. Variaveis que apresentaram valor de p<0,20 na analise bivariada foram inseridas em um modelo multivariado de regressao linear. Resultados: Os fatores associados com a sobrecarga foram: emprego formal (p=0,002), sentimentos na vida familiar (p<0,001), apoio financeiro (p=0,027) e ajuda nas Atividades da Vida Diaria (AVDs) (p<0,001). Conclusao: Os filhos que mais auxiliavam nas AVDs e prestavam apoio financeiro apresentaram maiores niveis de sobrecarga.

Depressive symptoms of the elderly people and caregiver’s burden in home care

OBJECTIVES To characterize the elderly population and their caregivers and to verify the association of depressive symptoms of the elderly and the caregivers burden with the variables of interest. METHODS A cross-sectional study with 80 elderly people and 78 caregivers in a Primary Health Service in southern Brazil. Retrospective collection conducted in a structured database based on the multidimensional evaluation tool applied to home care for the elderly participants and their caregivers. RESULTS Most elderly participants were women (71.3%), with an average age of 82.1 years and 52.6% reported sadness or discouragement. Systemic arterial hypertension was the most frequent morbidity (68.8%). Most caregivers were women (85.7%), daughters of the elderly person (53.2%), mean age 57.8 years and 38.7% reported feeling the burden. The presence of depressive symptoms in the elderly was associated with Parkinsons disease (p=0.016) and to have a male caregiver (p=0.006). Caregivers burden was associated with daily life activities such as bathing (p=0.021). CONCLUSIONS There was evidence of differences in caregivers gender in the presence of depressive symptoms and differences in the assistance in daily life activities for the caregivers burden.

Integrated care transitions: emergency to primary health care

Purpose – The purpose of this paper is to focus on the Integrated Care Transitions Project between the emergency department (ED) of a university hospital and primary health care (PHC) services in a large city in Southern Brazil was the focus of this study. Care transitions occurred through telephone contact for patients discharged from the ED to PHC. Design/methodology/approach – This descriptive, exploratory qualitative research collected data via semi-structured interviews (n=14) including interns of health disciplines, advisors for interns, nurses, and physicians from the ED and PHC Family Unit. A thematic analysis of the data were conducted. Findings – ED providers felt they gained increased knowledge of the care networks available for patients in the community. Connection between the providers in ED and PHC facilitated confidence in the services provided in the community and increased continuity of care for patients’ needs. The PHC providers recognized integration promoted communication and better ca...

Developing Legacy: Health Planning in the Host City of Porto Alegre for the 2014 Football World Cup.

AIM To describe the process adopted to identify, classify, and evaluate legacy of health care planning in the host city of Porto Alegre for the Football World Cup 2014. BACKGROUND There is an emerging interest in the need to demonstrate a sustainable health legacy from mass gatherings investments. Leaving a public health legacy for future host cities and countries is now an important part of planning for these events. PROCESS The Ministry of Sports initiated and coordinated the development of projects in the host cities to identify actions, projects, and constructions to be developed to prepare for the World Cup. In Porto Alegre, a common structure was developed by the coordinating team to instruct legacy identification, classification, and evaluation. This structure was based on international documentary analysis (including official reports, policy documents, and web-based resources) and direct communication with recognized experts in the field. FINDINGS AND INTERPRETATION Sixteen total legacies were identified for health surveillance (5) and health services (11). They were classified according to the strategic area, organizations involved, dimension, typology, planned or unplanned, tangible or intangible, territorial coverage, and situation prior to the World Cup. Possible impacts were then assessed as positive, negative, and potentiating, and mitigating actions were indicated. CONCLUSIONS The project allowed the identification, classification, and development of health legacy, including risk analysis, surveillance, mitigation measures, and provision of emergency medical care. Although the project intended the development of indicators to measure the identified legacies, evaluation was not possible at the time of publication due to time.

A Model of integrated care: an experience developed in the South of Brazil / Un modelo de atención integrada: una experiencia desarrollada en el sur de Brasil

Introduction: Health systems all over the world face fragmented care provision. Several models of integrated care have been proposed to overcome this situation by means of continuous and integral care. In Brazil, experiences are rare, although National Health Policies on this matter have been proposed. The model developed: A model to refer patients when they were released from an emergency department to primary health care (PHC) services of a specific area of a city in the South of Brazil was developed. In 2012 at a University Hospital patients who lived in that area were approached. Telephone contact and a written document with information about the treatment received and prescribed were the tools used by the emergency department and primary health care units. A mutually agreed care plan resulted from this contact. Objective: to analyze the effects of an integration model between services from different levels of complexity on the practice of health professionals involved and on the care offered to patients. Key findings: multiprofessional residents from the emergency department initiated the contact with physicians and nurses of the primary health care units. According to them, the exchange of information was mutual, resulting in a better dialogue between them and with the patients. An improvement of the knowledge that both teams had about each other’s services was also reported. Patients benefits included prioritized care in PHC, in which physicians and nurses could develop a care plan immediately after the patient was discharged from the hospital. Highlights: Although health professionals felt this model favored the integration between services, with decrease of the emergency department overcrowding, the Project was not followed. A better knowledge of the services provided specially in PHC and a closer approach to patients were mentioned as positive effects of the Project. Conclusion: This experience constitute evidence of good practices that could qualify the services and the care provided to patients and serve as a reference to be used in the development of 3 World Congress on Integrated Care, Mexico City, Mexico, 19-21 November, 2015 International Journal of Integrated Care – Volume 15, 17 Nov – URN:NBN:NL:UI:10-1-117329 – http://www.ijic.org futurre integrated care initiatives, contributing to the development of policies either in Brazil or elsewhere. Conference abstract Spanish Introducción: Los sistemas de salud de todo el mundo se enfrentan a la prestación de atención fragmentada. Se han propuesto varios modelos de atención integral para superar esta situación por medio de la atención continua e integral. En Brasil, las experiencias son raras, aunque se han propuesto Políticas Nacionales de Salud en esta materia. El modelo desarrollado: Un modelo para referirse a los pacientes cuando fueron liberados de un servicio de urgencias de atención primaria de salud de servicios (APS) de un área específica de una ciudad en el sur de Brasil fue desarrollado. En 2012 en un paciente del Hospital de la Universidad que vivía en esa zona fueron abordados. Teléfono de contacto y un documento escrito con información sobre el tratamiento recibido y prescritos fueron las herramientas utilizadas por el servicio de urgencias y unidades de atención primaria de la salud. Un plan de cuidado mutuo acuerdo el resultado de este contacto. Objetivo: analizar los efectos de un modelo de integración entre los servicios de diferentes niveles de complejidad en la práctica de los profesionales de la salud implicados sobre la atención ofrecida a los pacientes. Principales conclusiones: residentes multiprofesionales de el servicio de urgencias iniciaron el contacto con los médicos y enfermeras de las unidades de atención primaria de la salud. Según ellos, el intercambio de información fue mutuo, lo que resulta en un mejor diálogo entre ellos y con los pacientes. También se informó de una mejora del conocimiento de que ambos equipos tuvieron los servicios de uno sobre el otro. Los beneficios de los pacientes incluyen atención priorizada en la APS, en la que los médicos y enfermeras podrían desarrollar un plan de atención inmediatamente después de que el paciente fuera dado de alta del hospital. Lo más destacado: Aunque los profesionales de la salud sintieron que este modelo favorece la integración entre los servicios, con la disminución del hacinamiento de servicio de urgencias, el Proyecto no se siguió. Un mejor conocimiento de los servicios prestados en especial en la APS y un enfoque más cercano a los pacientes fueron mencionados como los efectos positivos del proyecto. Conclusión: Esta experiencia constituye una prueba de las buenas prácticas que pueden calificar los servicios y la atención a los pacientes y servir de referencia para utilizar en el desarrollo de iniciativas de atención integral a futuro, que contribuyen al desarrollo de las políticas, ya sea en Brasil o en otros lugares.