Rafael del-Pino-Casado

Subjective Burden and Cultural Motives for Caregiving in Informal Caregivers of Older People

PURPOSE The aims of this study were to investigate variables related to cultural caregiving motives (obligation and reciprocity) and to analyze the relationship between these cultural caregiving motives and subjective burden in informal caregivers of disabled older people. DESIGN AND METHODS A secondary analysis of the last cross-sectional Spanish survey of informal caregivers of older people (n= 1,284, probability sample) was performed. Measurements included sociodemographic characteristics of caregivers (gender, age, relationship with care recipient, primary caregiver status, and duration of caregiving), intensity of care (hours per week, type of care, and number of activities of daily living [ADL] assisted), cultural motives for caregiving (obligation and balanced reciprocity), and caregiver subjective burden. Statistical analyses included descriptive (means, percentages, and 95% confidence intervals), bivariate (chi-square test), and multivariate (binary logistic regression) analyses. FINDINGS Obligation and reciprocity were higher in spouses than in other relatives and in nonrelatives and obligation increased with age as well as providing help with ADL. Balanced reciprocity was high in men. Obligation was not related with subjective burden, whereas balanced reciprocity was positively related. CONCLUSIONS Reciprocity had a protective effect on subjective burden. No cultural differences have been found on this issue. Obligation may be a multidimensional concept that encompasses personal beliefs and social demands. CLINICAL RELEVANCE Balanced reciprocity is useful for early prevention and early intervention of subjective burden and must be included in nursing care plans for caregivers. Cultural factors support the comprehension of the caregiving process.

Gender Differences Regarding Informal Caregivers of Older People

PURPOSE The aim of this study was to examine differences related to gender among informal caregivers serving older disabled individuals. DESIGN AND METHODS A secondary analysis of the most recent national cross-sectional survey, which was conducted in Spain on informal caregivers who served older individuals (65 years of age or older), was conducted in 2011 (N= 1,272, probability sample). The relationships between gender and intensity of care (amount and type of care provided), duration of caregiving, subjective burden, and satisfaction with caregiving were analyzed by bivariate and multivariate procedures. FINDINGS No statistically significant gender differences were found with regard to the intensity of care, duration of caregiving, or satisfaction; however, subjective burden was found to differ between men and women, and this difference was statistically significant (odds ratio = 1.98; p= .012). CONCLUSIONS Because this study was conducted in Spain, a country with strong patriarchal norms with regard to caregiving and familism, whereas gender differences in intensity of care have been reported in countries with low familism, we conclude that cultural diversity can influence the relationship between gender and intensity of care. On the other hand, our study increases the evidence in support of there being gender-based differences in subjective burden among family caregivers serving older people in Western industrial countries. Finally, the results of our study support the hypothesis that sources of satisfaction are more strongly related to the caregivers personal context and characteristics than to his or her gender. CLINICAL RELEVANCE These findings support the following recommendations regarding nursing interventions: (a) nurses should take into account specific cultural patterns in caregiving to improve their understanding concerning the relationships between gender and intensity of care, and (b) gender should be taken into account in interventions that are tailored toward addressing subjective burden.

Cultural Correlates of Burden in Primary Caregivers of Older Relatives: A Cross-sectional Study

PURPOSE To analyze the effect of cultural factors on the subjective burden of primary home caregivers of older relatives. DESIGN Cross-sectional study. Primary home caregivers (N = 208) of older relatives were recruited in Spain using systematic random sampling. METHODS The data were collected in 2010 through interviews. The measures included sociodemographic characteristics, stressors (the intensity of care provided and the care-recipients needs; the latter were assessed using the Barthel Index, the Pfeiffer Short Portable Mental Status Questionnaire and the Cummings Neuropsychiatric Inventory), cultural factors (kinship ties, common residence, perceived social support, and cultural motives for caregiving), and caregiver subjective burden (Caregiver Strain Index). The data were analyzed using bivariate procedures and multiple linear regression. FINDINGS After controlling for caregiver age, caregiver gender, stressors, and duration of caregiving, subjective burden was negatively associated with perceived social support and reciprocity, and in the subgroup of adult children, it was positively associated with common residence. Cultural factors explained 29% of the variance in burden. CONCLUSIONS Our findings add to the existing evidence regarding the influence of cultural factors in the perception of burden in caregiving situations. CLINICAL RELEVANCE A risk profile could be proposed for subjective burden in primary family caregivers. Individuals who are at risk are characterized as young, offspring who live with the care recipient, care for a care recipient with behavioral problems, are unsatisfied with the social support received, and have a low balanced reciprocity.

Effectiveness of a Brief, Basic Evidence‐Based Practice Course for Clinical Nurses

BACKGROUND Barriers to the implementation of evidence-based practice (EBP) by nursing professionals include a lack of knowledge, inadequate skills in searching for and appraising evidence, and consulting research articles. However, few studies have addressed the effectiveness of educational interventions to improve their competence. AIMS To evaluate the effectiveness of a brief basic online and face-to-face educational intervention to promote EBP attitudes, knowledge and skills, and practice in clinical care nurses. METHODS This study was quasi-experimental, pretest-posttest design with a comparison group. The sample included registered nurses enrolled in the free continuing education courses offered in 2013 by the Nursing Council of Jaén (Spain). The study included 109 participants (54 in the intervention group and 55 in the comparison group). The intervention was a brief, basic EBP course with online and face-to-face learning. The comparison group received an educational intervention with different content. The evidence-based practice questionnaire (EBPQ) was used to evaluate EBP attitude, knowledge and skills, and practice before the intervention, and at 21 and 60 days following the intervention. Two-way mixed analysis of variance was conducted. RESULTS There was a significant difference between intervention and comparison groups in the knowledge and skills dimension. The difference between groups was not significant in the EBP practice dimension. Both groups had high scores in the attitude dimension that did not change after the intervention. LINKING EVIDENCE TO ACTION A brief basic educational intervention on EBP with online and face-to-face learning can produce improvements in the knowledge and skills of clinical nurses.

Obligation and negative consequences in primary caregivers of dependent older relatives

The purpose of this study was to analyse the multidimensional nature of obligation and the relations between each dimension of obligation and both anxiety and depression. A secondary analysis of data from two cross-sectional studies of primary home caregivers (N = 400; probabilistic sample) of older adult relatives in Spain was conducted. Data regarding obligation (four categories basing on beliefs of obligation and social pressure: low pressure and low beliefs, low pressure and high beliefs, high pressure and low beliefs and high pressure and high beliefs), stressors, anxiety and depression were collected by interview in 2013. The combination of high pressure and low beliefs had the highest levels of anxiety and depression, and the combination of low pressure and high beliefs had the lowest levels of anxiety and depression. When the relation of behavioural problems with anxiety and depression stratified by the previous four categories of obligation was analysed, behavioural problems were associated with anxiety and depression in the subgroups with low beliefs of obligation, whereas this association disappeared in the subgroups with high beliefs of obligation.

Social support and subjective burden in caregivers of adults and older adults: A meta-analysis

Background Despite the generally accepted belief that social support improves caregiver adjustment in general and subjective burden in particular, the literature shows mixed findings, and a recent review concluded that the predictive strength of caregiver social support in determining caregiver burden is less evident, due to the conceptual diversity of this determinant. Objective The purpose of this review is to analyse the relationship of perceived and received social support with subjective burden among informal caregivers of an adult or older adult. Methods A systematic search was carried out up to September 2017 in the following databases: MEDLINE (PubMed), CINAHL, EMBASE, PsycINFO), Scopus and ISI Proceedings, and a meta-analysis was performed with the results of the selected and included studies. Results Fifty-six studies were included in the meta-analysis, which provided 46 independent comparisons for perceived support and 16 for received support. Most of these studies were cross-sectional. There was a moderate, negative association of perceived social support on subjective burden (r = -0.36; CI 95% = -0.40, -0.32) and a very small, negative association of received support on subjective burden (r = -0.05; CI 95% = -0.095, -0.001). Conclusions 1) perceived and received support are not redundant constructs, 2) the relationships between social support and subjective burden depend on whether the social support is measured as perceived or received, 3) the relationship of perceived social support with subjective burden has a bigger effect size than that of received social support, the relation between received support and subjective burden being clinically irrelevant, 4) perceived social support may be a good predictor of subjective burden. Implications of key findings Our findings broadly support interventions promoting social support in caregivers to prevent or alleviate subjective burden, and specifically, to intervene on the promotion of perceived social support more than on the promotion of received social support when preventing or alleviating burden.

The start of caring for an elderly dependent family member: a qualitative metasynthesis

BackgroundThe family often takes care of an elderly person who suddenly becomes dependent. This greatly affects different aspects of the caregivers’ lives. The aim of this study is to explore the initial experiences, during the first year of care, of persons who suddenly become caregivers for elderly dependent relatives.MethodsA search in CINAHL, PsycINFO, WOS, Medline, and Scopus and a metasynthesis of qualitative research were conducted including 19 articles.ResultsThree categories were developed to explain the process of becoming a caregiver ‘taking on the role’ (life changes, uncertainty and confusion, and acceptance or resistance); ‘beginning to realise’ (new needs, impact, and appraisal); and ‘implementing strategies’ (seeking help and self-learning, reordering family and social relationships, solving problems, and devising strategies to decrease negative emotions and stress).ConclusionsThe synthesis provides a comprehensive understanding of the experience of becoming a caregiver in order to help health-care professionals to adapt care plans to this situation.

Coping strategies and quality of life in caregivers of dependent elderly relatives

BackgroundDespite the importance of coping in caregiving, there are few studies on the relationship between coping and quality of life in caregivers of the frail dependent elderly. Thus, this study aims to analyze the relationship between coping strategies and quality of life dimensions in primary caregivers of dependent elderly relatives.MethodsA cross-sectional study was conducted from 86 caregivers. Predictive variables were coping strategies (problem-focused, emotion-focused, socially-supported, and dysfunctional); dependent variables were quality of life dimensions (psychological, physical, relational, and environmental); and potential confounding variables were age, gender, perceived health and burden of caregiver, and functional capacity of care receiver. Correlation coefficients were calculated and multiple linear regression analysis was performed.ResultsAfter controlling for potential confounders, dysfunctional coping was related to worse quality of life in the psychological dimension, while emotion-focused and socially-supported coping were related to superior psychological and environmental dimensions of quality of life. The physical and relational dimensions of quality of life were not related to coping strategies.Conclusions1) it is important to consider coping strategies in the assessment of primary caregivers of dependent elderly relatives; 2) the quality of life of caregivers is related to their coping strategies, 3) their quality of life can be worsened by avoidance-type coping, and 4) their quality of life can be improved by active emotion-focused coping and socially-supported coping.