Submitted by Heloisa Silva (heloisa.silva@utp.br) on 2018-05-10T14:20:58Z No. of bitstreams: 1 OS SIGNIFICADOS DO CUIDAR.pdf: 1454327 bytes, checksum: 6e32e4df6fbede1bbf1742f073328483 (MD5) / Made available in DSpace on 2018-05-10T14:20:58Z (GMT). No. of bitstreams: 1 OS SIGNIFICADOS DO CUIDAR.pdf: 1454327 bytes, checksum: 6e32e4df6fbede1bbf1742f073328483 (MD5) Previous issue date: 2015-04-29 / This study was developed in order to understand the meanings of caring, in the vision of family caregivers, of hospitalized elderly. The theoretical- methodological basis was guided on the contributions of Social Constructionism, based on the guiding perspective of Community Social Psychology. It’s about a qualitative research, descriptive and exploratory. Data collection was made by semi-structured interviews, recorded on audio and based on a script with pre-formulated questions. Participants in the research were 15 primary and secondary family caregivers of elderly people over 65 years, hospitalized at a public hospital in Curitiba. On analysis it was used the method of discursive practices, proposed by Jane Mary Spink. The following categories were set: “Provided care”, “Caring the elderly related factors”, “Emotional aspects involved in accompanying the hospitalized elderly" and "Conditions provided by the hospital”, followed by their respective subcategories. Data analysis showed that among those interviewed, the female figure stands out, those being mostly daughters. In the speeches of the participants, we could observe that in between the meanings of taking care, in the vision of family caregivers, they assigned some characteristics regarded as difficult and exhausting, like the aid of personal needs of the dependent elderly, requiring a lot of responsability, dedication, patience and willpower and although this task is carried out with attention, fondness and pleasure, it carries the involvement of obligation feelings, duty and reward related to the good times experienced with the elderly, as well as negative feelings, such as anger, humiliation and sadness. The data shows the complexity of the process of taking care of a dependent elderly and the burden to the family caregiver, pointing out the need to supportive strategies and building new possibilities of attention to this social group in public hospital institutions, as well as the involvement of the multidisciplinary team included in the health/disease process. So, knowing the meaning of caring through the caregiver allows analyzing the responsibilities and detect the need for social support, witch contributes to a better caring and life quality of the caregiver, the elderly and his family. / Este estudo foi desenvolvido com o objetivo de compreender os significados do cuidar na visão do cuidador familiar de idosos hospitalizados. O embasamento teórico metodológico foi pautado nas contribuições do Constucionismo Social, tendo como base norteadora a perspectiva da Psicologia Social Comunitária. Trata-se de um estudo qualitativo, descritivo e exploratório. A coleta de dados foi realizada por meio de entrevistas semiestruturadas, gravadas em áudio e com base em um roteiro de perguntas previamente formuladas. Participaram da pesquisa 15 cuidadores familiares primários e secundários de idosos com idades superiores a 60 anos, internados em um hospital público da cidade de Curitiba. Na análise dos dados foi utilizado o método das Práticas discursivas, proposto por Jane Mary Spink. Foram elaboradas quatro categorias: “Cuidados prestados”, “Fatores relacionados ao cuidar do idoso, “Aspectos emocionais envolvidos no acompanhamento ao idoso hospitalizado e Condições oferecidas pelo hospital”, seguidas de suas respectivas subcategorias. A análise dos dados mostrou que entre os entrevistados se destacou a figura feminina, sendo na maioria, filhas. Nos discursos dos participantes pôde-se observar que aos significados do cuidar na visão do cuidador familiar, foram atribuídas algumas características tidas como difíceis e cansativas, como o auxílio nas necessidades pessoais do idoso dependente, demandando muita responsabilidade, dedicação, paciência e força de vontade e embora essa tarefa seja realizada com atenção, carinho e prazer, traz também o envolvimento de sentimentos de obrigação, dever e retribuição, relacionados aos bons momentos vivenciados junto ao idoso, além de sentimentos negativos como raiva, humilhação e tristeza. Os dados coletados mostram a complexidade do processo de cuidar de um idoso dependente hospitalizado e a sobrecarga procedida ao cuidador familiar, apontando à necessidade de estratégias de apoio e construção de novas possibilidades de atenção a esse grupo social nas instituições públicas hospitalares, que possibilitem acolhimento e acomodação durante o período dedicado ao cuidado, bem como, o engajamento da equipe multidisciplinar envolvida no processo saúde/doença. Assim, conhecer os significados de cuidar por meio do cuidador familiar, permite analisar as responsabilidades assumidas e detectar a necessidade de apoio social que possa contribuir para uma melhor assistência e qualidade de vida do cuidador, do idoso e da família.

The perspective of the caregiver is vital to understanding the experiences of raising a child with autism, including the challenges faced in accessing services. The purpose of this qualitative, transcendental phenomenological study was to examine the lived experiences of primary caregivers raising a school-age child with autism and to bring about an understanding of the challenges faced in accessing services. Resiliency theory provided the conceptual framework for the study. Semi-structured, in-depth interviews were conducted with 11 participants raising a child with autism in the Washington, DC metropolitan area. Data were analyzed using Moustakas's descriptive approach. Results yielded 5 themes: overall experience, challenges, relationships, access to services, and stressors. Findings revealed effective ways to support caregivers through programs and services and highlighted the importance of supportive relationships and family connections. Implications for social change include opening conversations regarding the unique perspectives and needs of primary caregivers of children with autism, supporting awareness of the stressors associated in daily caregiving, and engaging in broader discussions regarding the importance of establishing supportive relationships among physicians, mental health providers, specialists, social workers and care managers in order to support the advocacy efforts of caregivers.

Ways in which the implementation of the Patient Protection and Affordable Care Act (ACA) affect parents with chronically ill children are not well understood. The purpose of this phenomenographic study was to gain greater insight into the perceived experiences of parents of chronically ill children regarding implementation of the ACA in a southern state. Argyris's intervention theory provided the framework for the study. Face-to-face interviews were conducted with a purposeful sample of 12 female parents who are caregivers of chronically ill children. Data were analyzed and coded to identify categories and themes. Findings indicated that parents view physicians and policymakers as key actors in their communities to create more equitable services for parents of chronically ill children through the expansion of Medicaid services in southern state. Many participants did not perceive that the ACA had made significant changes to services received prior to its implementation. Findings may assist health care providers, insurance companies, legislators, and other policymakers to develop appropriate health care policies and interventions to lessen the financial burden experienced by parents of chronically ill children. Providing more support services that address the physical, emotional, and financial needs of parents may improve the health outcomes of their chronically ill children.

The purpose of this research is to investigate the relationship between early intervention providers’ backgrounds, and their perceptions of caregiver coaching and auditory skill development, to develop professional development programs. An explanatory sequential design was used with participants of varying backgrounds and experience. In the first phase of the study, participants responded to a survey regarding their educational background, and their comfort with caregiver coaching and auditory skill development. Survey results were analyzed using Spearman’s Ranked Correlational Coefficient (Spearman’s rs) to form groups of participants from extreme cases. The second phase of the study consisted of participant interviews from each of the groups. Interviews were coded to identify themes present within and between groups. The information from both phases were analyzed to generate how professional preparation and certifications influence service delivery. Results were subsequently analyzed to determine potential improvements in the EI system, professional development, and policy.

Purpose: Evaluate behavior assessment and agreement among dentist, guardian, and child. Evaluate child behavior by appointment type. Methods: Patients recruited from the pediatric dental department at Virginia Commonwealth University for this convenience sample. Inclusion criteria: patients presenting for clinical exams and/or restorative treatment without the use of advanced behavior guidance between August 29, 2018, and March 7, 2019; ages 4-12-years-old; and scheduled with a single clinician. Appointments were stratified by difficulty. Behavior was assessed by dentist and caregiver using the Frankl Scale. Patient self-assessed cooperation using an age-appropriate modified Frankl Scale, developed for this study. Agreement assessed among the 3 scores at each appointment using descriptive statistics and Cohen’s Kappa. Behavior trends across appointment type assessed using Kruskal-Wallis test. SAS software (2013, Cary, NC). P-value < 0.05. Results: Forty-one patient-guardian dyads enrolled in the study. Five dyads experienced multiple encounters. Demographics for the patients enrolled: 59% male; 44% Caucasian, 29% African American, 5% Asian, 2% Hispanic, 20% other/multiracial. Average patient age: 7.6 (range: 4- 12). Most patients had 1 encounter (n=36, 88%). Frankl Score agreement for provider/guardian was 79% (k=0.335), provider/child was 70% (k=0.248), and guardian/child was 81% (k=0.314). In disagreements, guardians rated behavior better than provider. Disagreement was split for provider/child and guardian/child, with the child tending to rate themselves higher, and the guardian tending to rate the child higher respectively. Marginal evidence that hard appointments resulted in poorer behaviors. Conclusion: There is fair agreement between child, guardian, and provider. In disagreements, guardians tend to rate the child’s behavior better compared to the provider and child self-assessment. Dental providers tend to be more critical of patient behavior. Marginal evidence to support harder appointments result in poorer behaviors.

Child sexual abuse is a global issue that has affected children, families, and communities for centuries regardless of socioeconomic, religious, ethnic, race, or multicultural factors and distinctions. Sexually abused children may be reluctant to disclose sexual abuse due to perceptions or realities that their nonoffending caregiver (NOC) will not believe their reports and may fail to provide adequate protection. The purpose of this quantitative study was to assess if child demographics (i.e., age, sex, and race/ethnicity); type of sexual offense (i.e., contact or noncontact); and perpetrator relationship to the child (i.e., familial or extrafamilial) predict a NOC's response (i.e., protection or failure to protect) to child sex abuse disclosures, using cognitive dissonance theory and neutralization theory as theoretical foundations. Archived and extracted data (2015-2017) were utilized from the Utah Department of Human Services. A binary logistic regression was used to determine the predictive quality of the independent variables for the outcome variable. The results indicated that the odds of protection were greater for non-White females experiencing noncontact abuse by a familial offender. Age was not a statistically significant predictor of NOC protection in the full model. The findings from this study support positive social change by providing research-based conclusions that can promote prevention, intervention, and education programs by child protection teams for victims of child sexual abuse and their families.

African Americans suffer disproportionately higher incidence of congestive heart failure (CHF) at an earlier age of onset and with more rapid progression compared to other races. Due to this escalating prevalence of CHF within the African American population and the lack of culturally responsive support for the caregiving role, African American family caregivers of adult CHF patients face greater challenges and suffer increased caregiver burden, stress, depression, and financial strain compared to European American caregivers. The purpose of this project was to conduct a systematic literature review to find the recommendations that target African American family caregivers of adult CHF patients. The Joanna Briggs Institute model for systematic review (JBIM-SR), and the caregiver stress theory proposed by Tsai, guided this project. A review of multiple databases yielded 118,078 articles. After removal of duplicates and exclusion of articles not consistent with the purpose of the review, 1 article was selected. A second reviewer completed an independent search of the databases using the same exclusion/inclusion criteria and identified the same review. The selected article was analyzed and graded using the JBIM-SR grading tools. Family Heart Failure Home Care, a telephone coaching intervention adapted to the cultural preferences of the African American family caregivers of adult CHF patients, was suggested as an effective culturally sensitive intervention. Results of this project can promote positive social change by improving the care and well-being of the African American community. Nurses at the project site can use the findings to provide evidence-based care to the African American family caregivers of adult CHF patients.

The fast growth of the Chinese oldest old population indicates higher demand for long-term care. In China, families assume the primary responsibility of caring for older adults. Since the oldest elders are more likely to be widowed, their adult children usually become their caregivers. Focusing on the Chinese adult children who provide care for their oldest-old parents, this study documented and helped to explain Chinese adult children's caregiving strain. A conceptual framework was developed based on Pearlin's stress process theory, Higgins' framework of self-concept discrepancy, and previous studies on family caregivers of elders. Using an existing dataset from the 2005 Chinese Longitudinal Healthy Longevity Survey of 895 caregivers and their care recipients, the researcher tested whether and how caregiving context (caregiver's structured context and care recipients' needs for care), caregiving performance, and sibling support were related to five types of caregiving strain including sacrifice strain, exhaustion strain, capability strain, expectation strain, and dependency strain. The results indicate that caregiving context and caregiving performance are statistically related to different types of caregiver strain. Three independent variables in the set of caregiving context, self-evaluation of living standard, education, and cultural identity, were related to two types of caregiver strain in different directions. The caregivers who were the eldest sons, who were females caring for female elders, who had a close relationship with their care recipients, who lived with the care recipients, who provided care for the elders with more needs for care in ADL (Activities of Daily Living), or whose care recipients had health insurance reported higher levels of at least one type of caregiver strain. Care recipients' cognitive status and entitlement to pension were negatively related to at least one type of caregiver strain. Caregivers' rural residence, having a job outside the family, having a child under age 16, and care recipient's needs for care in IADL (Instrumental Activities of Daily Living) were not found to be related to any type of caregiver strain. Monetary assistance, which was indicated by the proportion of their annual household per capita income that the caregivers provided to care recipients, was found to be positively related to caregivers' capability strain. The amount of time spent in caregiving (time assistance) was positively related to three types of caregiver strain: exhaustion, expectation, and dependency strain. Time assistance was also found to mediate the relationship between care recipients' needs for care in ADL and caregivers' exhaustion strain and the relationship between dependency strain and three caregiving context variables: closeness between caregivers and care recipients, co-residence with care recipients, and care recipients' needs for care in ADL. The results revealed the importance of caregiving context and caregiving performance in explaining Chinese adult-child caregivers' experience and the necessity of investigating caregiver strain in different dimensions. This study contributes to understanding caregiver strain from a filial perspective. The results imply directions for future research, social work practice and education, and policy legislation in addressing Chinese adult children's strain in caring for their oldest-old parents.

An estimated 14 million people in the United States currently have chronic obstructive pulmonary disease (COPD). This nonreversible illness causes progressively decreasing airflow and is manifested by frequent episodes of acute and chronic dyspnea. The purposes of this study were: 1) to examine the relationships between mastery (MS), negative affectivity trait (NA), perceptions of patient dyspnea severity (DSI), and perceptions of which dyspnea interventions are effective (DE) among family caregiver-COPD patient dyads and 2) to examine the degree of agreement between the dyad members regarding dyspnea assessment and management. The study subjects were elderly (patients = 71.6 years, caregivers = 63.4 years), mostly women (patients = 60%, caregivers = 63.3%), Caucasian (96.7%), and patients had severe/very severe COPD (80%). No significant differences were found between family caregivers' and patients' ratings of MS, NA, DSI, or DE. The most effective dyspnea management strategies identified by both dyad members included changing activity, relaxation, inhaled medication use, and altering breathing pattern. The study conceptual model was tested to identify the interrelationships between the study variables. Significant effects in the patient model were between DSI and NA (p = 0.04), DE and gender (p = 0.04), DE and education (p = 0.015), and between DE and disease severity (p = -0.026). The caregiver model demonstrated no significant effects between the study variables. Significant effects in the dyad model were between DSI and the length of time caregiving had been provided (LOT, mean = 25.2 years) (p = 0.013), DE and DSI (p = 0.004), and between DE and LOT (p = 0.03). Gender, education, disease severity, LOT, and DSI influenced DE. Negative affectivity and LOT (mean = 25.2 years) influenced DSI. The findings of this study indicate that when the family caregiver of a patient with COPD is present, he or she is able to provide valid and reliable assessments of the patient's dyspnea severity. During acute exacerbations of dyspnea, persons with COPD are often unable to speak for themselves and these experienced family caregivers may be valuable partners with nurses and other healthcare providers to represent the patient's responses and needs.

Diarrheal disease has long been known to be a burden to children worldwide. Although child mortality rates as a result of diarrhea have decreased over the past two decades, overall diarrhea incidence has remained relatively stable. In Cambodia, diarrhea was the third most prevalent outpatient diagnosis for children under five in 2012, with a reported incidence rate of 12 per 100 children, up from 7 per 100 children in 2008 (Ministry of Planning Cambodia, 2012). Cambodia is an agricultural country with 80% of the population living in rural areas (National Institute of Statistics Ministry of Planning, 2013). Many are also poor, with 20.5% of the population living at or below the poverty line (Sobrado et al., 2014). As a result, a large portion of the population is vulnerable to changing climate patterns and seasonal rainfalls. These patterns have been shown to have an effect on the incidence of diarrhea in regions throughout the world. This research evaluated the relationship between seasonality and the incidence of diarrheal disease in children under five years old in the Rumduol district, Svay Rieng province of Cambodia. Using monthly under-five diarrhea data from a local health center and meteorological data from the Ministry of Water Resources and Meteorology (MoWRAM), Spearman’s Correlation was used to find associations between monthly rainfall, heavy rainfall (defined by the 90th percentile), maximum average monthly temperature, and minimum average monthly temperature. Additionally, household surveys, interviews, and observations were used to understand how seasonal behavior, age/gender, household practices, and caregiver perception of the disease affect decisions surrounding diagnosis and treatment of childhood diarrhea throughout the year. Based on the results of the analysis, the number of heavy rainfall days had a weak negative association with monthly under-five diarrhea incidence in the initial month and following month, referred to as lag 0 and lag 1 (rs(96) = -.216, p = .035 and rs(95) = -.219, p = .033). Minimum average monthly temperature was also shown to have weak negative association with monthly under-five diarrhea incidence at lag 0 and lag 1 (rs(96) = -.208, p = .042 and rs(95) = -.212, p = .039). The negative correlation between heavy rainfall and under-five diarrhea indicates that heavy rain can have a washing effect on the environment at lag 0 and lag 1 months. Higher diarrhea incidence in the cooler months suggest a possible link to rotavirus, however more research must be done to make confirm this. Monthly rainfall was seen to have a positive association with diarrhea within the lag 3 and lag 4 months (rs(93) = .250, p = .015; rs(92) = .222, p = .034). This indicates that increased rainfall could have a delayed effect on diarrhea by three or four months. Maximum temperature did not have statistically significant results. These results show that heavy rainfall and minimum temperature likely play role in under-five child diarrhea in the study area at shorter lags times, while monthly rainfall has a greater effect at longer lag times. Results of survey and interview data showed participants had sufficient knowledge on personal and food hygiene practices but often practiced improper environmental hygiene behavior, especially as it related to the handling of child and animal feces. Additionally, there were statistically significant results when looking at the relationship between environmental hygiene knowledge and practice and households where mothers migrate for work. Households with migrant mothers was common within the study area, with 51.9% of households having a mother who was currently working away from home or had plans to return to work soon. More data is needed to further investigate this relationship; however, this result suggests that hygiene knowledge and practice could suffer in households where the mother is absent, as added burden is placed on grandmothers to do domestic and childcare work.