Perspectives from family caregivers receiving home nursing support: findings from a qualitative study of home care patients with heart failure

Many heart failure (HF) patients depend on a family caregiver and many families need additional home care nursing support. This qualitative study identified perspectives of being a HF caregiver for families receiving home care nursing. Eleven caregivers of homebound HF patients were interviewed on what helps them the most, their own health, obstacles in caregiving, and greatest needs overall. Eight themes emerged and will be discussed in this article. The findings articulate the positive influence nurses can have on HF families to guide future practice and research.     

对心力衰竭患者健康教育需求的调查

目的确定对住院心衰患者进行健康教育的内容及方式.方法对协和医院护士和心衰患者各40例进行问卷调查,让他(她)们对问卷8个主题、48项及6个学习方式按Likert5点评分方法进行打分,然后输入计算机用Statistic软件包进行统计处理.结果患者对心衰常识、药物治疗、预后、危险因素,活动和心理6项的重要性感受明显强于护士(P<0.05),而对饮食项的重要性感受低于护士(P<0.05).患者对除了心理项外其它7项的可行性感受明显强于护士(P<0.05).排序方面,患者把药物治疗、症状和预后3项重要性排在前3位,把症状和药物治疗2项可行性排在前2位.对学习方式的认识,患者把交谈和印刷品的重要性排在最前位.结论这8个主题是心衰患者学习的重要内容,其中药物治疗,症状和预后是非常重要的,采取的健康教育方式最好是交谈和印刷品.     

Perceived loneliness and social support in patients with chronic heart failure

Self-reported conditions have become increasingly important in patient care, and perceived loneliness and social relationships in patients with chronic heart failure (CHF) are not sufficiently investigated.

Aim

The aim was to investigate perceived loneliness and social support in patients with CHF. Further, to investigate whether loneliness and social support might be associated with gender, age, healthcare utilization and mortality.

Methods

One hundred and forty nine patients with CHF, hospitalised at least once during a 4-month period in 2006, completed a self-reported questionnaire including measurements about loneliness and social support. Healthcare utilization was assessed prospectively by frequency of readmissions and number of days hospitalised during 1 year.

Results

Loneliness was reported by 29 (20%) participants. They were more often women (p < 0.001) and younger (p = 0.024). Patients who perceived loneliness had fewer social contacts (p = 0.033), reported lower occurrence of emotional contacts (p = 0.004), were less satisfied with social contacts and close relationships (p < 0.001). Those reporting loneliness had more days hospitalised (p = 0.044), and more readmissions to hospital (p = 0.027), despite not having more severe CHF.

Conclusion

Loneliness is a health-related risk indicator in that patients with CHF who perceived loneliness have more healthcare utilization than those who do not report loneliness despite not having more severe CHF.     

Multidisciplinary approach for circulatory support in patients with advanced heart failure

Despite the efficacy of heart-failure (HF) therapy, patients may still decompensate and require hospitalization. In addition to the gap between guidelines and clinical practice, this highlights the need for a multidisciplinary approach to the management of HF. The third European Mechanical Circulatory Support Summit presented the latest trials and trends in conservative therapy of end-stage HF (ESHF) and the alternative options over a ten-session program. The meeting covered topics such as epidemiological trends, different HF registries and guidelines for ESHF therapy. In addition to databases and HF trials, the presenters discussed the integration of multiple biomarkers in HF stratification, biological solution and embryonic stem cells for HF therapy, up-to-date myocardial recovery and the surgical aspects of ESHF treatment. Therapeutic options following short-term left ventricular support were discussed, such as: which patients should receive a ventricular assist device (VAD) and when; what the perfect window for implantation of a VAD is; bridge-to-bridge and device selection; VAD-weaning criteria; left ventricular unloading, patient–device matching (short-term device), cardiac transplantation following short-term support. There was a device update, presenting Circulite^®, Abiomed Impella^®, Levacor?, Levitronix^®, VentrAssist?, Heartmate ^®II, DuraHeart? and Heartware. Finally, the International VAD registry, European VAD registry and The International Society for Heart & Lung Transplantation Mechanical Circulatory Device database were also discussed. Herein, a commentary is givenon some of the interesting topics that indicate the importance of the community, the physician and the patient’s awareness of HF, the utilization of the updated guidelines and landmark studies and registries, as well as recent evidence-based modalities in the management of ESHF.     

Telephone support for caregivers of patients with cancer

Caregivers have complex needs as they care for a loved one with cancer at the end of life. The objective of this pilot study was to determine the feasibility of conducting a brief telephone intervention, Tele-Care II, for caregivers of hospice patients. Guided by Hogan's Model of Bereavement, nurse interventionists implemented Tele-Care II via teleconference calls with caregivers. Although 14 caregivers were recruited for the study, only 5 were able to complete the intervention before the patient's death. Those completing the intervention experienced decreased depression, despair, and disorganization although the patient's condition became more serious. Late enrollment in hospice continues to be problematic for patients, family caregivers, and hospice staff because it allows little time for completion of interventions with family caregivers before the patient's death.     

Factors associated with caregiver burden in heart failure family caregivers

Fifty caregivers and 41 heart failure patients participated in a study examining the association of caregiver characteristics and the caregiving environment on caregiver burden. Using a cross-sectional design, caregivers were interviewed face-to-face using a caregiver characteristic/demographic tool designed for this study, the Centers for Epidemiological Studies Short Depression Scale, the Caregiver Reaction Assessment questionnaire, and the New York Heart Association Functional Classification Guide to obtain the caregiver's perception of patient disease severity. Patient medical records were assessed following caregiver interviews for patient demographics, comorbidities, and ejection fraction percentages. Significantly higher levels of burden were found among Caucasian caregivers, those caring for other relatives besides the patient, unemployed caregivers, and single- versus two-family caregivers (respite caregiving). Fifty-one percent of the variance in caregiver burden was accounted for by the variables caregiver advanced age, higher caregiver hours, more caregiver physical health problems, higher levels of caregiver depressive symptoms, and more patient comorbidities. This article concludes with implications for nursing practice and future research.     

慢性心力衰竭家庭照顾者的负担及影响因素相关分析

目的了解慢性心力衰竭家庭照顾者的负担及影响因素。方法采用照顾者一般资料调查表、Zarit负担量表和社会支持评定量表调查照顾者情况,采用患者一般资料调查表和日常生活能力量表调查患者情况,对数据进行单因素分析和多因素分析。结果慢性心力衰竭家庭照顾者的负担得分为6～76分。患者合并其他疾病数、日常生活能力和照顾者性别、是否与患者同居住、照顾者社会支持度是照顾者负担的影响因素。结论慢性心力衰竭家庭照顾者的负担水平处于低水平,受较多因素影响,提高患者的自理能力及对照顾者的支持度,可减轻照顾者负担。     

社区慢性心力衰竭病人家庭照顾者心力衰竭知识水平现状调查

[目的]了解社区慢性心力衰竭病人家庭照顾者心力衰竭知识水平及其影响因素。[方法]采用一般资料调查表和亚特兰大心力衰竭知识问卷对155例社区慢性心力衰竭病人家庭照顾者进行调查。[结果]社区慢性心力衰竭病人家庭照顾者的心力衰竭知识得分为17.66分±3.98分;得分低水平者(答对率低于60%)占43.9%;照顾者答对率后5个条目为低盐饮食的标准、液体摄入量的控制方法、身体疼痛时非处方药的选择、接种流感、肺炎疫苗以及监测体重的频率;不同文化程度的照顾者其心力衰竭知识得分差异有统计学意义(P<0.05),文化程度越低者相关知识得分越低。[结论]社区慢性心力衰竭病人家庭照顾者的心力衰竭知识水平处于低水平,医护人员进行健康教育时,应注意评估教育对象的接受能力并采取个体化、持续性的健康教育,以提高其相关知识水平。     

慢性心力衰竭患者照顾者反应及其影响因素研究

目的探讨慢性心力衰竭患者主要照顾者反应情况,并分析其影响因素。方法采用一般资料调查表、照顾者反应评估量表和抑郁自评量表对慢性心力衰竭患者与主要家庭照顾者各130例进行问卷调查。结果慢性心力衰竭患者照顾者反应及抑郁得分较高。慢性心力衰竭患者照顾者反应的影响因素为照顾者的自尊、健康问题、时间安排受打扰、经济问题以及家庭支持缺乏。结论慢性心力衰竭患者照顾者反应及抑郁得分较高,临床医护人员应该重视慢性心力衰竭患者照顾者反应情况,并根据慢性心力衰竭患者照顾者的自尊、健康问题、时间安排受打扰、经济问题以及家庭支持缺乏情况采取针对性的措施,降低慢性心力衰竭患者照顾者反应及抑郁现状,从而提高慢性心力衰竭患者及照顾者的生活质量。     

慢性心力衰竭患者社会支持现状的调查研究

目的:探讨慢性心力衰竭患者社会支持现状,为临床护理人员完善患者住院期间社会支持系统提供依据。方法:我们对120例慢性心力衰竭患者应用肖水源设计的社会支持调查量表(SSRS)进行调查,观察比较患者社会支持总分与社会常模情况。结果:慢性心力衰竭患者社会支持总分(30.43±7.05)分低于全国常模得分(33.03±7.16)分(P<0.05);患者社会支持水平与医疗方式、年龄、病程、在职状况、月收入及文化程度存在相关性(P<0.05)。结论:护理人员应及时评估患者社会支持状况,制订相应护理计划,完善患者现有社会支持系统,使患者维持良好的身心状态,为疾病的治疗和康复提供有利条件。     

社区慢性心力衰竭患者自我护理水平及其照顾者疾病管理行为的调查

目的 了解社区慢性心力衰竭患者的自我护理水平及其照顾者疾病管理行为.方法 采用非概率抽样法,用中文版欧洲心力衰竭自我护理行为量表和慢性心力衰竭患者的家庭照顾者疾病管理行为问卷分别调查155例社区慢性心力衰竭患者及其家庭照顾者.结果 社区慢性心力衰竭患者的自我护理行为得分为(36.96±8.86)分,患者的家庭照顾者疾病管理行为得分为(55.26±15.38)分.社区慢性心力衰竭患者家庭执行最差的管理行为是患者每年接种流感疫苗、限制患者每日液体摄入量及对患者体液潴留的监测.结论 社区慢性心力衰竭患者的自我护理水平及其家庭照顾者的疾病管理行为总体状况不佳,医疗卫生行政部门应尽快建立以家庭为中心的慢性心力衰竭康复/二级预防保健体系,同时医务人员应采取系统的、个体化的教育和出院后的延续护理,以提高患者的自我护理水平和家庭照顾者的疾病管理水平.     

Family caregivers of patients with frontotemporal dementia: An integrative review

ObjectivesThe purpose of this integrative review is to: (1) identify the characteristics of family caregivers of patients with frontotemporal dementia, (2) explore the impact of providing care on family caregivers’ health and well-being, and (3) identify coping strategies used by family caregivers.BackgroundFrontotemporal dementia is thought to be the second most common form of dementia after Alzheimer's disease. Family caregivers of patients with frontotemporal dementia face unique challenges due to its early onset, behavioral symptoms, and slow progression of decline. However, there is a dearth of research evaluating the health and wellbeing of family caregivers of patients with frontotemporal dementia.Design and data sourcesAn integrative review was conducted using the Whittemore and Knafl methodology. An electronic search of the literature was conducted using four electronic databases: PubMed, Embase, CINAHL, and Web of Science. The Crowe Critical Appraisal tool was used to evaluate the quality of the selected articles.ResultsFindings of 11 articles informed this integrative review. Family caregivers of patients with frontotemporal dementia identify behavioral disturbances as most troubling. Spouses and female caregivers experience greater caregiver burden, distress, increased rates of depression, as well as decreased sleep related to behavior disturbances. Though less explored, providing care to those with behavioral disturbances may also impact caregiver physical health. Additionally, female caregivers are most likely to employ coping strategies, most commonly, adaptation and reframing. Effective interventions to reduce family caregiver burden are poorly understood but family caregivers suggest education and internet-based support groups are most helpful.ConclusionsFamily caregivers of patients with frontotemporal dementia experience significant distress, which impacts their health and wellbeing. It is important for healthcare providers who care for patients with frontotemporal dementia to recognize the unique needs of family caregivers. Future research should focus on examining interventions and strategies to reduce caregiver burden.