Victoria Steiner

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.

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.

Information Needs of Family Caregivers of Persons With Cognitive Versus Physical Deficits

This study compared information needs of caregivers of persons with dementia with caregivers of those who received rehabilitation treatment. Caregivers were provided a 48-item survey and asked to choose their top ten information needs. Dementia caregivers (n = 33) top needs were dealing with forgetfulness/confusion (91%) and repeating questions/actions (61%) in care recipients. Rehabilitation caregivers (n = 40) top needs were handling care recipients mobility problems (75%) and dealing with their own stress (65%). Dementia caregivers focused on care recipients needs related to behavioral symptoms, whereas rehabilitation caregivers focused on needs related to physical care of care recipients and their own needs.

The impact of a web-based caregiver intervention on the reasons stroke survivors use health care services during the first year post treatment.

Abstract Purpose: A Web-based education/support intervention for caregivers of stroke survivors was developed. A prospective, descriptive design was used to identify caregivers’ reported reasons for stroke survivors’ health care service use (i.e., health care provider and emergency department visits, hospital readmissions) during the first year after initial treatment. Method: Caregivers were recruited in the Midwest and randomized into an experimental (Web users, n = 36) or control (non-Web users, n = 37) group. Telephone interviews were conducted with the caregivers every 2 weeks. Reported reasons were organized by group and time period in which the service occurred (i.e., Months 1–6 or 7–12; 1-year totals). Content analysis and descriptive statistics were used to analyze these data. Results: Two themes emerged: wellness- and problem-oriented reasons for health care service use. Web users reported a large percentage of visits for rehabilitations reasons, which may have subsequently contributed to the musculoskeletal issues of this group. Laboratory work and testing was considered by both groups as a primary reason for provider visits. Non-Web users reported that medication adjustment was a common reason for provider visits. They also had more emergency department visits and hospital admissions for cardiology or pulmonology reasons. Conclusion: This study informs professionals about the care and needs of stroke survivors and provides direction for education and supportive interactions with caregivers and survivors.

Information Needs of Family Caregivers of People With Dementia

Purpose: Understanding caregiver needs is essential when caring for people with dementia. The aim of this study was to identify family caregivers information needs as perceived by home care workers and the caregivers themselves. Design: This study used a descriptive survey design and convenience sampling. Methods: The two groups of care providers were given a list of 48 items and asked to choose caregivers top 10 information needs. Findings: Group 1 (n = 33 unpaid family caregivers) identified dealing with behavior changes and group 2 (n = 59 paid home care workers) identified providing personal care as most important. Conclusion: While differences between these groups emerged, both care providers chose more items related to needing help for the care recipient, than items related to needing help for the caregivers themselves, e.g., support group. Clinical Relevance: These information needs can be used by rehabilitation nurses and other healthcare professionals to develop educational materials and supportive interventions.

Perceived Experience of Caring for a Wife with Stroke

&NA; This article presents a 55‐year‐old husbands perceived experience of caring for his wife with stroke, as learned from his 1 year of participation in a Web‐based support intervention study. In a secondary analysis of data, his narrative entries (n = 213) were coded and drawn to Friedemanns framework of systemic organization. The themes that emerged from these data were that of the caregiver providing support, offering solutions, and taking control. Friedemanns system maintenance process dimension was the area that captured most of his experience, which indicated that this caregiver spent a significant amount of his energy in creating control and stability within his environment to maintain congruence or balance in his life. These findings can be used to identify and design interventions, which for male spousal caregivers, affect the quality of their lives.

Family caregivers’ reports of hospitalizations and emergency department visits in community-dwelling individuals with dementia

Individuals with dementia in the United States have higher rates of hospitalizations and emergency department visits compared to those without. This descriptive study examined the frequency of hospitalizations and emergency department visits among community-dwelling individuals with dementia, reasons for hospitalizations and emergency department visits, and caregivers’ actions to prevent these events. Family caregivers (nu2009=u200963) from education/support groups offered through Alzheimer’s Association chapters in western Ohio completed a survey. Twenty-two percent of caregivers reported that their care recipient stayed overnight in the hospital and 30% reported that their care recipient visited the emergency department at least once in the past three months. The most frequent reasons for hospitalization and emergency department visits, such as urinary tract infections and fall-related injuries, were potentially avoidable. Caregivers reported giving medications, seeking healthcare services, and obtaining home care services, as the most frequently used preventive actions. Family caregivers of individuals with dementia should be provided substantive education about preventable hospitalizations and emergency department visits.

Linking Theory with Qualitative Research through Study of Stroke Caregiving Families

Purpose: This theoretical article outlines the deliberate process of applying a qualitative data analysis method rooted in Friedemanns Framework of Systemic Organization through the study of a web‐based education and support intervention for stroke caregiving families. Methods: Directed by Friedemanns framework, the analytic method involved developing, refining, and using a coding rubric to explore interactive patterns between caregivers and care recipients from this 3‐month feasibility study using this education and support intervention. Specifically, data were gathered from the interventions web‐based discussion component between caregivers and the nurse specialist, as well as from telephone caregiver interviews. Findings and Conclusions: A theoretical framework guided the process of developing and refining this coding rubric for the purpose of organizing data; but, more importantly, guided the investigators thought processes, allowing them to extract rich information from the data set, as well as synthesize this information to generate a broad understanding of the caring situation.

Predictors of depression among older adults with dementia

Dementia and depression are common disorders among elderly populations. Their frequent co-morbidity and similar presentations create a complex clinical scenario for the health care professional. The objective of this study was to determine common characteristics of older adults with dementia that were associated with depression. Data from a retrospective chart review of 242 patients visiting an outpatient geriatric clinic were analyzed to determine the potential relationship between depression and several social- and health-related variables. Results from regression analysis show that taking greater numbers of medications and living in a less independent environment were both associated with greater depression, while using alcohol was associated with less depression. This information could be easily obtained during an office visit and used to help identify patients who suffer from dementia and are at risk for depression and require further evaluation.

Perceptions of reciprocity in friendship by community dwelling people with mild to moderate dementia

Positive social interaction is important for people with dementia, providing emotional and psychological benefits. Friendships may retain more reciprocal balance than caregiver relationships, which often become one-sided. This qualitative study investigates the meaning that friendship has for people with dementia, and how reciprocity relates to positive social identity. Individuals experiencing dementia were recruited from programs sponsored by a Midwest chapter of The Alzheimer’s Association. In a face-to-face, one-time interview, participants were asked to share their perceptions about reciprocal friendship. Participants included 10 individuals who were primarily White, averaged 76 years old, with at least some college education. The data were analyzed using a phenomenological approach that revealed five themes of reciprocal friendship: recognizing the importance of longevity in friendship, helping one another is a normal part of friendship, feeling “alive” through the give and take in friendship, knowing somebody is there for them, and seeking security through friendship.