Det finns idag i Sverige många personer som har drabbats av en demenssjukdom. Att drabbas av demenssjukdom påverkar hela familjen och de närstående får ofta dra ett tungt lass vid vården av den sjuke. Många närstående sliter dygnet runt och löper därför stor risk att drabbas av hög stressbelastning och depression som följd. Demenssjukdom kan delas in i olika typer så som frontotemporal demens, Alzheimers sjukdom, vaskulärdemens. Olika typer av demens ger olika symtom men gemensamt är att de alla ger en kognitiv och känslomässig påverkan med bland annat nedsatt minnesfunktion, rastlöshet och oro. Syftet med studien var att undersöka vilka behov närstående som vårdar en demenssjuk i hemmet kan ha för att som sjuksköterska kunna stödja på bästa sätt. I denna studie har det använts elva artiklar varav sex är kvalitativa och tre kvantitativa samt två artiklar som var blandstudier med både kvalitativa och kvantitativa inslag. Analysen av materialet resulterade i två huvudkategorier vilka är kunskap om sjukdomen och kunskap om stöd som kan erbjudas, samt sex underkategorier. Resultatet visar att närstående har ett stort behov av utbildning och information, vilket de i dag inte tycker att de får tillräckligt av. De behöver dels kunskap om sjukdomen för att kunna förstå och ge en god vård, samt kunskap om sjukdomens utveckling för att kunna planera för framtiden. Det visar sig också att många närstående inte får tillräckligt information om hur de skall få kontakt med olika instanser, samt hur de kan söka olika stödåtgärder så som korttidsplats, dagverksamhet och avlösning i hemmet. För att närstående skall orka sköta den dagliga vården av den sjuke är det viktigt att han eller hon får tid att ta hand om sig själv. Som sjuksköterskor är det viktigt att ha en bra utbildning och en god förståelse för hur närstående och sjuka upplever sjukdomen, för att kunna ge en korrekt information samt att kunna stödja på bästa sätt.

Background: Heart failure (HF) is a leading cause of hospitalization, readmissions, and death in the United States. Patients hospitalized for HF are at risk for readmission, in- hospital mortality, and early post-discharge death. In the United States, inpatient care has been estimated to cost $83,980 over the lifetime of each patient with HF. The majority of patients with HF depend on caregiver support for successful HF self-care, which is essential for optimal patient outcomes. Support from caregivers is thought to be important for better self-care, and lower readmission and mortality rates. Yet, there are few studies considering the influence of caregivers on HF patient self-care, readmission, and mortality. Objective: The purpose of my dissertation was to determine the influence of HF caregivers on patient self-care, readmission, and mortality. The specific aims of this dissertation were to: (1) to determine if caregiver depressive symptoms mediate the relationship between family functioning and caregiver quality of life, (2) to determine if there is an association between living arrangements (living with someone vs. living alone) and all-cause readmission and death in patients with HF, and (3) to determine the efficacy of an in-hospital, multi-session, educational intervention for caregivers on heart failure patients’ self-care and 30 day readmission rate, and to evaluate the efficacy of the intervention on caregivers’ knowledge, self-efficacy and perceived control. Methods: Specific aim one was addressed by a secondary analysis of data from one- hundred and forty-three HF caregivers recruited from an outpatient clinic. Multiple regression with mediation analysis was used to determine whether depressive symptoms mediated the relationship between family functioning as measured using the three scales of the Family Assessment Device (i.e., general, problem-solving, communication) and caregiver quality of life. Specific aim two was addressed by a retrospective chart review of all 398 patients with a primary diagnosis of HF admitted to an academic medical center in one year. We collected data on patient sociodemographic, clinical characteristics, and patient living condition. The independent association of living alone with all-cause readmission or all-cause death was evaluated using Cox proportional hazards modeling adjusting for covariates. Specific aim three was addressed using a two-group (educational intervention for caregivers of patients with heart failure vs. usual educational care), prospective, repeated measures randomized controlled trial of 37 patient and caregiver dyads in which caregivers only received in-hospital HF education. Outcome measures included patient self-care, and patient all-cause readmission or all- cause death, as well as caregiver self-efficacy, knowledge, and perceived control. Patient self-care, and caregiver self-efficacy, knowledge, and perceived control were assessed at baseline (in hospital), at discharge, 7 and 30-days after patient discharge. Patient readmissions and death were assessed by a phone call at 30-days follow-up. The intervention directed only at caregivers consisted of three in-hospital, educational sessions with telephone follow-up. The educational sessions were designed to deliver HF information and skills to caregivers, thereby providing them with the resources needed to improve their self-efficacy, perceived control and HF knowledge thus improving patient self-care and readmission rates. Results: Specific aim one: The three subscales of the Family Assessment Device predicted depressive symptoms (p < 0.001) and caregiver quality of life (p < 0.001). Depressive symptoms also predicting caregiver quality of life (p < 0.001). The inclusion of depressive symptoms in the final model with each subscale of the Family Assessment Device (i.e., general family functioning, problem-solving, communication) decreased the significance of family functioning as a predictor of caregiver quality of life indicating mediation by depressive symptoms. Specific aim two: Heart failure patients living with someone experienced a significantly longer time to rehospitalization than those living alone (290 vs. 201 days, p=0.005). In a Cox regression hazard regression model, adjusting for covariates, patients who lived alone were 1.42 times more likely to be rehospitalized one year after discharge than those who lived with someone (p=0.013). The relationship between living alone and all-cause death was not significant after adjustment for covariates. Specific aim three: A linear mixed-model analysis revealed that patients whose caregiver was in the intervention group had significantly better self- care maintenance (p < 0.001) and self-care management (p < 0.001) across time. Cox survival analysis demonstrated that patients whose caregiver did not receive the educational intervention were 11 times more likely (p=0.002) to experience cardiac readmission than patients whose caregiver did receive the educational intervention. Caregivers who received the educational intervention had higher perceived control (p < 0.001) for up to 30-days post-intervention versus the control group, however, there were no differences between caregiver groups in self-efficacy and HF knowledge. Conclusion: In this dissertation, we found caregivers to play an important part in improving patient outcomes of self-care and readmission after discharge from a hospitalization for HF. Future large-scale studies are needed to develop and test interventions focused on caregivers to improve both patient and caregiver outcomes. Such studies will assist clinicians in understanding how better to support caregivers in their ability to positively influence HF self-care and readmission rates in patients with HF.

Dementia care is an immediate and growing issue that affects everyone. People are living longer increasing the likelihood that they may be diagnosed with dementia. Friends and family are become caregivers but are often unprepared for the role. The purpose of this project was to develop a 15-minute dementia care module to assist caregivers with the home care of dementia patients. A pamphlet was created to reinforce the module information and to provide a quick reference for dementia support. The self-efficacy theory, along with the review of best practice guidelines and evidence from literature, informed the development of the module. The Simple Measure of Gobbledygook (SMOG) and the Flesch Reading Ease scales were used to ensure that the written materials were at an appropriate reading level for the targeted group. A single group evaluation was used to determine whether caregivers would be able to understand and use the information. A total of 5 lay dementia caregivers volunteered to evaluate the dementia module and related pamphlet. They volunteered to provide feedback using Appraisal of Guidelines for Research and Evaluation (AGREE) tool. Four out of the 5 caregivers strongly agreed or agreed that the module met the designated criteria. All participants stated that the information presented in the module/pamphlet was applicable to their circumstance as dementia caregivers, that the information would assist to provide better care for their loved one, and that they would recommend the dementia module to other caregivers. This project will have a positive impact on social change by providing dementia caregivers with strategies and information to deliver quality dementia care for their loved ones.

Caregiving for a close family member with Alzheimer’s disease is a stressful situation to be in, that often leads to high levels of caregiver burden and subsequent stress and depressive symptoms, and while there are numerous community and government resources available to caregivers, there are aspects of Hispanic cultures that may lead Hispanic caregivers to have higher levels of caregiver burden and depressive symptoms than White caregivers. 80 Hispanic caregivers and 80 White caregivers, with 40 males and 40 females within each group, will be recruited to participate in this study. Scales will be administered to both Hispanic and White caregivers in order to assess levels of caregiver burden, depressive symptoms, familism values, gender role beliefs, acculturation levels, and knowledge, comfort, and use of community resources. Hispanic caregivers will have higher levels of caregiver burden and depressive symptom scores than White caregivers, while women will have higher scores overall than men overall. Hispanic caregivers will have less knowledge, comfort, and use of community resources than White caregivers, while gender role views, familism values, and acculturation levels will be mediating factors of these relationships. Cultural differences in caregiver burden need to be assessed further, so that clinical and practical implications for community and government resources can be discussed.

Magister Legum - LLM / This thesis explores the factors that our courts take into account in determining what would constitute the best interests of the child in granting or refusing relocation applications. This study deals with the formulation and interpretation of the best interests standard by South African courts in relocation cases. The courts are considering reported cases to determine which issues to take into account in determining the best interests of the child, due to the fact that the Children’s Act does not have a set list of criteria. Therefore I will focus on case law in determining what factors are taken into account in order to determine what would be in the best interests of the child with regard to the relocation application. The aim is to determine whether there is any consistent principle or policy which can act as a guideline to practitioners and our courts to direct jurisprudence in this area. The objective is to determine whether the Children’s Act provides sufficient guidelines to assist the court in determining relocation disputes. Furthermore the thesis examines what the approach of our courts is and what constitutional dimensions may arise in relocation disputes. The research aims to explore whether relocation applications (and parenting roles) are disadvantaging women (primary-caregivers). The research investigates whether the courts are gender neutral and acutely sensitive to gender in relocation applications.

No description available.

Informal caregiver burden and burnout can cause worsened outcomes of care for both the recipient of care and the caregiver’s overall health. Experiencing increased levels of distress by the caregiver may be the deciding factor for the elder remaining in the home or being placed in a long-term facility for care. Thus, healthcare professionals must be diligent in assessment for presence of a caregiver on admission, as well as identifying needs and providing education of resources within the community upon discharge. The purpose of this project is to implement admission screening for caregiver presence during the inpatient stay, with the goal of early communication to the interdisciplinary team. The project aims are as follows: a) to integrate the “Preparing for Caring” screening tool into the electronic health record, b) for nursing to provide education to the caregiver and assist with identification of needs during the inpatient stay, c) for nursing and the interdisciplinary team to collaborate with the caregiver during the inpatient stay to prepare for discharge, d) to provide education of resources available within the community upon discharge, and e) to include discussion of caregiver presence during the daily interdisciplinary team meeting. Program outcome measures will include use of aggregate data reports to determine the percentage of compliance for screening conduction, case review of identified caregivers, discharge education, and provision of a resource list upon discharge. Specified outcomes are being measured weekly during the implementation phase. As a result of the above, it will be determined if identification and subsequent intervention for informal family caregivers reduces readmission rate to an inpatient facility and the caregiver’s overall sense of burden in providing care upon discharge. Expected outcomes will be reduction in 30-day readmission to the inpatient geropsychiatry unit due to caregiver distress.

Stroke is the leading cause of long-term disability in the United States and often leaves individuals with physical and cognitive deficits. Stroke survivors are discharging to the home environment in increasing numbers rather than entering a long-term care facility. Family caregivers are needed to provide assistance for engagement in ADL, IADL, communication, and mobility tasks due to the residual deficits resulting from the stroke. Research indicates that caregivers are not adequately prepared in the inpatient setting to assume their new role and are therefore at risk for negative health outcomes and caregiver burnout. This doctoral project intends to address the need in the inpatient setting for proper and adequate caregiver education and training prior to a patient’s discharge home. The Post-Stroke Discharge Planning Toolkit and the caregiver perceived readiness questionnaire will address this need. Specifically, the toolkit will target education on stroke risk factors and complications; eating including swallowing, nutrition, hydration, PEG tube education; bowel and bladder care; positioning; caregiver self-care; supportive problem solving; facilitating of functional transfers, mobility, handling, and lifting; facilitating activities of daily living; communication; psychological aspects of caregiving; and referral services. The questionnaire will help identify gaps in knowledge faced by caregivers and serve as a planning tool and outcomes tool for intervention and evaluation. Ideally, through the use of the Post-Stroke Discharge Planning Toolkit, difficulty with discharge planning and negative health outcome risks associated with assuming the caregiver role can be mitigated or stopped prior to onset. The Post Stroke Discharge Planning Toolkit will be available in print and online.

Alzheimer's disease affects many people worldwide and is often cared for by a family member. It is not uncommon for family members to become caregivers. The aim was to describe the experiences of family caregivers in caring for a loved one with Alzheimer's disease. The method used was a literature review with a qualitative approach, conducted using Polit and Beck's (2020) nine-step model. Ten articles were identified and analyzed using thematic analysis. Results: The analysis resulted in three main themes and seven subthemes: Emotional reactions with subthemes: Transition from family member to caregiver, during the progression of the disease, fear for the future. The caregiver role with subthemes: Responsibility and duty, challenges and sacrifices, and the theme Need for knowledge and support and with the subthemes: Knowledge and Support. The conclusion shows that family members caring for their loved ones with Alzheimer's experience difficulties in handling the caregiver role, both emotionally and instrumentally. They often experience a lack of support from the healthcare system, highlighting the importance of nurses applying family-centered care. Suggestions for further research: Developing interventions to implement family-centered care.

No description available.