Strategies for Sustaining Self Used by Family Caregivers for Older Adults With Dementia

The negative health consequences of caring for an older adult family member with dementia are well documented. However, not all family caregivers experience these negative health consequences. The purposes of this study were to describe strategies family caregivers use to help them continue to provide care for an older family member with dementia despite challenges and describe these family caregivers’ resilience and psychological distress. A mixed methods design was used with a narrative approach dominant and standardized scales for resilience and psychological distress used to enhance the description of the sample. Data were collected through telephone interviews with 18 family caregivers residing in an urban area. The findings indicate that family caregivers used four strategies to sustain the self: drawing on past life experiences, nourishing the self, relying on spirituality, and seeking information about dementia. Understanding strategies used by family caregivers to sustain themselves is essential for providing holistic nursing care and developing effective interventions

Managing Delirium in Hospitalized Older Adults

Consequences of delirium for older adults may include increased mortality, functional decline, nursing home placement, and decreased quality of life. Longer duration of delirium is linked to poorer health outcomes among older adults, underscoring the need for early detection and intervention. Delirium also exacts a high economic price. Estimated annual U.S. healthcare expenditures range from $143 to$152 billion, with increased hospital stays contributing heavily. Delirium can be frightening for both patients and for family members who observe it in their loved ones. As a nurse, you can play a key role in identifying risk factors, detecting symptoms early, implementing nonpharmacologic interventions promptly, and educating family members about the disorder

Nurses’ Experiences Empowering Hospitalized Patients

Four focus groups were conducted to explore acute care nurses’ experiences empowering patients and the facilitators and barriers they encountered during the process. Thirty-four nurses employed at four hospitals in the Midwestern United States participated in the study between February and April 2015. Facilitators of empowerment included establishing a therapeutic relationship, fostering communication, providing education, respecting patient autonomy, engaging support systems, and lifting spirit/giving hope. Barriers included conflicting information about plans of care, lack of time, fear and anxiety over unfamiliar environments and routines, ineffective or inadequate support systems, lack of/low accountability, and killing the soul. Nurses also described innovative strategies they used to overcome the barriers. The development of future inpatient empowerment interventions needs to focus on the innovative strategies nurses used to overcome barriers in addition to considering the facilitators and barriers to empowerment that nurses identified

Family Caregivers’ Knowledge of Delirium and Preferred Modalities for Receipt of Information

Delirium is a life-threatening, frequently reversible condition that is often a sign of an underlying health problem. In-hospital mortality alone for older adults with delirium ranges from 25% to 33%. Early recognition of delirium is critical because prolonged duration poses a greater risk of poor functional outcomes for older adults. Family caregivers, who are familiar with the older adult’s usual behaviors, are most likely to recognize delirium symptoms but might dismiss them as due to aging. It is important to learn what family caregivers know about delirium to ascertain their need for education. The aims of this study were to describe family caregivers’ knowledge of delirium and preferred modalities for receipt of information about delirium. A cross-sectional design was used for this study and a survey distributed to family caregivers for older adults. Analysis of 134 usable surveys indicated that family caregivers need and want information about delirium. The preferred modalities for receipt of information included Internet, in-person classes, and newsletters

Public Health Model Identifies Recruitment Barriers among Older Adults with Delirium and Dementia

Recruiting older adults and their family caregivers into research studies presents challenges. Although the literature notes some general recruitment challenges, no studies specifically address the unique challenges of recruiting older adults who have Alzheimer\u27s Disease (AD) and their family caregivers in studies about delirium or suggest using a framework to identify barriers to recruiting this population. In conducting a pilot study about preparing family caregivers to detect delirium symptoms in older adults with (AD) the researchers used the Public Health Model for identifying barriers to recruitment. The goals of this methodological article are to: (1) briefly describe the methodology of the pilot study to illustrate how the Public Health Model was applied in the context of the present study and (2) discuss the benefits of the Public Health Model for identifying the barriers to recruitment in a study that prepared family caregivers to detect delirium symptoms in older adults with AD. The Public Health Model helped us to identify four specific barriers to recruitment (lack of knowledge about delirium, desire to maintain normalcy, protective caregiving behaviors, and older adult\u27s fears) and ways to overcome them. The Public Health Model might also help other researchers address similar issues

Educating Family Caregivers for Older Adults About Delirium: A Systematic Review

Background Delirium in older adults is considered a medical emergency; it contributes to a cascade of functional decline and to increased mortality. Early recognition of delirium symptoms is critical to prevent these negative consequences. Family caregivers who are educated about delirium could partner with nurses and other healthcare professionals in early recognition of delirium symptoms. Before implementing such partnership models, it is important to examine the effectiveness of educating family caregivers about delirium. Aims To examine whether providing education on delirium to family caregivers improved their knowledge, emotional state, or response in reducing the incidence of delirium in older adults. Methods For this systematic review, we conducted literature searches in CINAHL, Cochrane Library, Medline, PsycINFO, Web of Science, Social Sciences in ProQuest, Dissertations and Theses, and the Virginia Henderson Global Nursing eRepository for studies published in the English language between January 2000 and June 2015. Criteria for inclusion were: (a) primary focus on educating family caregivers for older adults about delirium; (b) use of experimental, quasi-experimental, or comparative design; (c) measured family caregiver outcomes of delirium knowledge, emotional state, or response in reducing delirium incidence in older adults; and (d) published in the English language. Articles were appraised using Melnyk\u27s rapid critical appraisal guides. Results Seven studies met the review criteria. Four studies found that family caregivers’ delirium knowledge increased; two noted that delirium incidence in older adults declined; and one study reported less distress following receipt of education. Linking Evidence to Action Providing family caregivers with information about delirium can be beneficial for both family caregivers and older adults. However, rigorous evaluation of education programs for family caregivers about delirium is needed

A Framework of Academic Persistence and Success for Ethnically Diverse Graduate Nursing Students

The goal of this qualitative study was to examine how ethnically diverse graduate nursing students persisted with academic studies. Ethnically diverse nurses are vastly underrepresented in the workforce. This problem is accentuated by high attrition rates in academic programs. A grounded theory approach was used. Five focus groups were conducted with 16 ethnically diverse graduate students in nursing and interviews were conducted with two diversity advisers. Analysis of the data indicated that the process of learning to balance stressors with moderators was key to academic persistence and retention. A conceptual framework emerged from the data that provides a guide for academic institutions seeking to implement strategies to promote retention and graduation of diverse graduate nursing students. Recommendations are offered to address faculty development, administrative action, and student resources. Aim. The goal of this qualitative study was to examine how ethnically diverse graduate nursing students persisted with academic studies. Background. Ethnically diverse nurses are vastly underrepresented in the workforce. This problem is accentuated by high attrition rates in academic programs. Method. A grounded theory approach was used. Five focus groups were conducted with 16 ethnically diverse graduate students in nursing and interviews were conducted with two diversity advisers. Results. Analysis of the data indicated that the process of learning to balance stressors with moderators was key to academic persistence and retention. A conceptual framework emerged from the data that provides a guide for academic institutions seeking to implement strategies to promote retention and graduation of diverse graduate nursing students. Conclusion. Recommendations are offered to address faculty development, administrative action, and student resources

Engaging Nursing Staff in Research: The Clinical Nurse Specialist Role in an Academic-Clinical Partnership

Purpose: The purpose of this article is to describe the processes of exploring and implementing an academic-clinical study, engaging nursing staff in research, and maintaining their enthusiasm within the context of an academic-clinical research partnership. Description: The core competencies of the clinical nurse specialist (CNS) role address evidence-based practice, quality improvement, and research. Studies and exemplars of the CNS role in the literature illustrate expert practitioner and facilitator of evidence-based practice, but less attention is given to methods used by the CNS to engage staff in clinical research. Outcome: The CNS was successful in obtaining staff engagement in the research project from exploration through sustainment. Conclusion: Collaborative research between academic and clinical partners enhances the educational and professional environment for students and clinicians, promotes evidence-based practice, and from this project may promote Veteran and family-centered care. The CNS played a key role in engaging and sustaining staff commitment, which contributed to the success of this study

Preparing Family Caregivers to Recognize Delirium Symptoms in Older Adults After Elective Hip or Knee Arthroplasty

Objectives To test the feasibility of a telephone-based intervention that prepares family caregivers to recognize delirium symptoms and how to communicate their observations to healthcare providers. Design Mixed-method, pre–post quasi-experimental design. Setting A Midwest Veterans Affairs Medical Center and a nonprofit health system. Participants Forty-one family caregiver-older adult dyads provided consent; 34 completed the intervention. Intervention Four telephone-based education modules using vignettes were completed during the 3 weeks before the older adult\u27s hospital admission for elective hip or knee replacement. Each module required 20 to 30 minutes. Measurements Interviews were conducted before the intervention and 2 weeks and 2 months after the older adult\u27s hospitalization. A researcher completed the Confusion Assessment Method (CAM) and a family caregiver completed the Family Version of the Confusion Assessment Method (FAM-CAM) 2 days after surgery to assess the older adults for delirium symptoms. Results Family caregivers’ knowledge of delirium symptoms improved significantly from before the intervention to 2 weeks after the intervention and was maintained after the older adult\u27s hospitalization. They also were able to recognize the presence and absence of delirium symptoms in the vignettes included in the intervention and in the older adult after surgery. In 94% of the cases, the family caregiver rating on the FAM-CAM approximately 2 days after the older adult\u27s surgery agreed with the researcher rating on the CAM. Family caregivers expressed satisfaction with the intervention and stated that the information was helpful. Conclusion Delivery of a telephone-based intervention appears feasible. All family caregivers who began the program completed the four education modules. Future studies evaluating the effectiveness of the educational program should include a control group

Psychometric Properties of the Family Caregiver Delirium Knowledge Questionnaire

A valid, reliable measure of family caregivers’ knowledge about delirium was not located in the literature; such an instrument is essential to assess learning needs and outcomes of education provided. The purpose of the current study was to (a) develop a family Caregiver Delirium Knowledge Questionnaire (CDKQ) based on the Symptom Interpretation Model; and (b) establish validity and reliability of the measure. The 19-item CDKQ was developed and administered to 164 family caregivers for community-dwelling older adults. Descriptive statistics were examined for all variables. Psychometric testing included confirmatory factor analysis, item-to-total correlations, and internal consistency reliability. A three-factor model provided the best fit for the data. The findings support initial validity and reliability of the CDKQ with family caregivers. Although the CDKQ was developed for use with family caregivers, it has potential for use with other caregivers, such as home health aides