Karen M. Robinson

Predictors of Use of Services Among Dementia Caregivers

Caregivers of persons with dementia do not use community resources until late in the disease process, despite the fact that judicious use of community resources can delay nursing home admission. Data from the National Caregiver Training Project, based on Hall and Buckwalter’s (1987) progressively lowered stress threshold (PLST) model, were used to examine variables related to use of community resources. Spouse and adult child caregivers were divided into two groups based on amount of community resources used per week. Within this geographically diverse sample of caregivers, 64% did not use professional services, 79% did not use respite services, and 65% did not use other services. Being a spouse decreased the odds that the caregiver would use community resources. Resource use was also related to the care recipient’s problems with activities of daily living and the increase in frequency of memory and behavioral problems.

Effects of Two Caregiver-Training Programs on Burden and Attitude Toward Help

The purpose of this research was to determine which caregiver-training program (CTP) was most beneficial to caregivers. Two types of CTPs, a behavior management program and a social skills program, were implemented. The effects of the CTPs on attitude toward asking for help, attitude about using adult day care, are caregiving burden were explored. Thirty-three caregivers volunteered to participate. Of the caregivers, the majority were female spouses (n = 22), 76% were over age 60, and 68% had some college education. Subjects were randomly assigned to one of two CTPs or a control group. Pretest was completed during the first phase of the training program. Both CTPs met for six sessions. The control group received no training. The posttest was conducted 1 month after completion of the CTPs. Differences between the three groups were analyzed by using ANOVA. No differences were observed between groups. Six of the subjects chose the alternate training program when given the opportunity for further training. Caregivers who participated in both CTPs experienced a decrease in objective burden and a more positive attitude toward asking for help and using adult day care.

Clinical nurse specialist practice within the Acute Care for Elders interdisciplinary team model.

As the complexity of care increases for hospitalized older adults, the clinical nurse specialist is essential for ongoing development of nursing practice and care standards. This article describes the Acute Care of the Elderly (ACE) model for interdisciplinary management of older adults and clinical specialist responsibilities within this interdisciplinary team. Within the model, clinical care specialists utilize clinical expertise and consultation skills reflecting three spheres of practice related to care of high-risk community-dwelling older adults admitted an acute medical unit. The goal for this patient group is to achieve medical stability while preserving maximum functioning. The Acute Care of the Elderly team members include primary nurses (staff nurses), physicians, clinical care specialists, therapies, social workers, dietitians, pharmacists, and a discharge planner. Under the leadership of the primarily nurse, the team develops a comprehensive care and discharge plan, implemented across a care continuum. Using protocols and working together, the team delivers cost-effective, coordinated care that promotes process improvement resulting in practice that is in alignment with current standards of care.

Differences Between Dementia Caregivers Who are Users and Nonusers of Community Services

OBJECTIVES To examine differences between users and non-users of community services in caregivers of persons with dementia (PWD). A profile of who used services versus did not use services was developed. DESIGN AND SAMPLE Existing cross-sectional data from the NINR funded National Caregiver Training Project (data collected 1995-1997) were used. The sample (N = 241) of caucasian, well-educated caregivers reflected a mix of spouse and adult caregivers with a mean age of 64.8 years. MEASURES Variables measured included caregiver social support, burden, and depression as well as problem behavior of PWD. RESULTS The majority of caregivers did not attend support groups (73%) or use respite services (79%). Among caregivers who did not use services, 78% lived with the recipient and 77% were spouses. The profile of non-users compared to users revealed that non-users were significantly older, more depressed, and received less social support. On the other hand, non-users provided fewer hours of care per week to recipients who had less cognitive and functional deterioration and fewer behavior problems. CONCLUSIONS These findings provide public health nurses with knowledge about service use in caregivers of PWD. Recommendations regarding caregiver needs for assistance and increased use of services before a crisis ensues are presented.

Wife caregivers' and supportive others' perceptions of the caregivers' health and social support

Perceptions of health and social support held by 75 wives caring for their mentally impaired husbands at home were compared with those of 75 supportive others, that is, secondary caregivers. Ratings by the two groups were significantly correlated, suggesting that the reports of wife caregivers may be considered valid. Supportive others rated physical help received by wife caregivers significantly higher than did the caregivers. Nondepressed caregivers perceived themselves to be significantly healthier than their supportive others perceived them. Depressed caregivers reported larger social networks than did their supportive others. Findings point to the importance of gaining the perspectives of both primary and secondary caregivers in order to understand the total reality of the caregiving situation.

Supervision as professional development for psychiatric mental health nurses.

Clinical supervision is an essential element in the professional development of advanced practice psychiatric mental health nurses, and many interpersonal approaches exist to facilitate this process. This article discusses the issues underlying supervision, the key elements of the supervision process, and the current literature focused on the development of best practices in the conduct of clinical supervision. Recommendations for the implementation of supervision are identified.

Prevalence of chronic illnesses and characteristics of chronically ill informal caregivers of persons with dementia

OBJECTIVES to examine the prevalence of and the link of chronic illnesses (CIs) to informal caregivers of persons with dementia (PWDs), as well as to identify characteristics of caregivers with CIs. METHODS the sample included 124 caregivers of PWDs from a caregiver programme of research. Sociodemographic information and caregivers CIs were collected by an in-person interview. Descriptive statistics, t-tests, chi-square analysis and binary logistic regressions were performed for data analysis. RESULTS approximately 81.5% (n = 101) of caregivers reported having at least one CI, 60.5% (n = 75) reported two or more CIs. Caregivers with CIs were more likely to be older and unemployed; advanced age and female gender were risk factors for CIs. The link of CIs to caregivers was stronger in younger caregivers but weaker in older caregivers when compared with the general population. CONCLUSION targeted interventions based on this study need to be developed to improve the health of caregivers of PWDs.

Development of integrated mental health care: Critical workforce competencies

In integrated care, a person will have his or her medical and behavioral health needs addressed within one health care system. Support for integrated models has grown with the increasing awareness of how the medical comorbidities of individuals with serious mental illness contribute to their morbidity and mortality, the prevalence of mental health problems in the general population, and the mental health issues among those with chronic medical problems. The enactment of effective integrated care will demand developing clinicians who are trained to work with mental health needs at various levels of intensity, who are capable of addressing complex comorbidities, and who operate from a person-centered approach to care. In this light we argue that given their unique skill set and clinical training, Psychiatric-Mental Health Advanced Practice Nurses could play a critical role in integrated care and present policy recommendations which support the development of the Psychiatric-Mental Health Advanced Practice Nurses role in such models.

An integrated mental health clinical rotation.

The most common site for accessing mental health care is the primary care setting. Yet, primary care nurses are not adequately prepared to treat the complex mental health needs of these patients. Similarly, providers in segregated mental health sites do not adequately address physical health needs. New educational models are needed to better prepare nursing graduates to provide holistic care. The integrated mental health model, which colocates mental health specialists in primary care sites, is designed to do this. This article describes key curricular elements of a successful interprofessional clinical rotation within an integrated mental health team that included the use of case studies, a standardized mental health screening instrument, a quality improvement process, and a patient satisfaction questionnaire. Family nurse practitioner and psychiatric mental health nurse practitioner students learned to collaborate with each other and with other members of the interprofessional team to provide holistic care.

THE FAMILY'S ROLE IN LONG-TERM CARE

Long-term care provided by family members is the central care of our current health care system. The purpose of this article is to review the familys role in long-term care. Issues such as cost containment and inequities in our current social policy are reviewed. Suggestions for future directions in social policy are presented.