Needs and problems related to sociodemographic factors of informal caregiving of people with heart failure: A mixed methods study in three European countries

Aims To explore caregivers' needs and problems in three European countries and associate the clusters of caregivers' needs with their sociodemographic characteristics. Design A qualitative focused mixed methods design was used. Methods In total, 52 caregivers of heart failure (HF) people were interviewed in three European countries between March 2017 and December 2018. Transcripts were analysed using the seven-phase method of the exploratory multidimensional analysis according to Fraire with Reinert lexical classes findings were organized in dendrograms. Mayring's content analysis was also performed. Results Three clusters of caregivers were identified: spouses, adult children and non-family members. Caregivers not only provide HF patients with vital unpaid support for their physical and emotional needs, but they are continually trying to cope with their social isolation and deteriorating health. Conclusions Informal caregiving emerged as a complex process influenced by various sociodemographic factors. Gender, relationship type and economic status are the important factors to be considered planning to develop approaches to address the needs of caregivers serving people with heart failure. Impact A comprehensive understanding of the nature of informal caregiving of individuals with heart failure, the complexity of the real-world sociodemographic and cultural factors is warranted. The use of the EMDA method gave us the possibility of processing large masses of qualitative data through rapid, complex calculations. In detail, AATD allowed us to study in deep the significant fuzziness of what caregivers expressed and to analyse the content of the entire interviews and to produce global knowledge by using multi-dimensional statistical methods to grasp the fundamental sense of the interviews, beyond the simple words. Three clusters were identified in the samples, including spouses, adult children and non-family members. This study demonstrated that some sociodemographic characteristics could lead to everyday needs. Therefore, these demographic characteristics should be considered in developing targeted interventions. The research was conducted in Europe, but the technique shown can be replicated everywhere. The findings not only impact nursing but can be extended to all those stakeholders who concur with a public health educational mission. Patient or Public Contribution Carers were involved in this study after the discharge of their loved ones or at the time of the outpatient visit. They were involved after they had been observed in their dynamics of involvement in caring of the familiars or friends with heart failure

Hyperkalemia and electrocardiogram manifestations in end-stage renal disease

Hyperkalemia is one of the more common acute life-threatening metabolic emergencies. The aim of our study is to determine the correlation and accuracy of abnormal ECG parameters as a function of serum potassium concentration in the end-stage renal disease (ESRD) population. We performed a retrospective chart review of emergency department patients presenting with ESRD and receiving emergent hemodialysis treatment. A total of 96 patients, each with five independent ED visits, provided 480 sets of ECGs and electrolytes. Of these, four ECGs were excluded for inability to interpret, leaving a total of 476 patient encounters that met all inclusion criteria. Linear regression analysis on the limited data set for serum potassium versus T/R in V2, V3, and V4, PR, and QRS found weak correlations (

Burden among informal caregivers of individuals with heart failure: A mixed methods study

AIMS: To develop a comprehensive understanding of caregiver burden and its predictors from a dyadic perspective. METHOD: A convergent mixed methods design was used. This study was conducted in three European countries, Italy, Spain, and the Netherlands. A sample of 229 HF patients and caregivers was enrolled between February 2017 and December 2018 from the internal medicine ward, outpatient clinic, and private cardiologist medical office. In total, 184 dyads completed validated scales to measure burden, and 50 caregivers participated in semi-structured interviews to better understand the caregiver experience. The Care Dependency Scale, Montreal Cognitive Assessment, and SF-8 Health Survey were used for data collection. Multiple regression analysis was conducted to identify the predictors and qualitative content analysis was performed on qualitative data. The results were merged using joint displays. RESULTS: Caregiver burden was predicted by the patient's worse cognitive impairment, lower physical quality of life, and a higher care dependency perceived by the caregivers. The qualitative and mixed analysis demonstrated that caregiver burden has a physical, emotional, and social nature. CONCLUSIONS: Caregiver burden can affect the capability of informal caregivers to support and care for their relatives with heart failure. Developing and evaluating individual and community-based strategies to address caregiver burden and enhance their quality of life are warranted

Psychometric testing of the Care Dependency Scale in patients with heart failure and their caregivers

Aims: This study aims to (i) test the validity and reliability of the Care Dependency Scale (CDS) for patients with heart failure (HF) and (ii) test the validity and reliability of the proxy version of the CDS assessing informal caregivers' perception of the dependency level of individuals with HF. Methods and results: Secondary data analysis was conducted of transnational multicentre cross-sectional design study. A convenience sample comprised of HF patients-informal caregivers' dyads in three European countries. The CDS was administered to patients and the proxy version to informal caregivers. Factorial validity was tested for each scale using confirmatory factor analysis. Reliability was evaluated with the composite coefficient and Cronbach's alpha. Construct validity was tested via known group differences. Measurement error was tested to assess responsiveness to changes. A total of 229 patients and 208 caregivers were recruited. Confirmatory factor analysis supported the two-factor structure (Physical Care Dependency and Psychosocial Care Dependency) of the CDS in both HF patients and their caregiver. Reliability estimates were adequate for all reliability coefficients. Construct validity was supported. The measurement error was adequate. Conclusion: The scale shows acceptable validity and reliability and can be useful for care dependency assessment of patients with HF and their informal caregivers. Further research is needed for assessing the validity and reliability in other cross-cultural settings. The use of the CDS has the potential to effectively enable the development of pertinent care plans, taking dependency into consideration including the perspective of both members of the dyad as a whole

Perception and Challenges of Time Management for Caregivers of People with Heart Failure: A Qualitative Study

Background: Informal caregivers contribute substantially to the self-care of people with heart failure (HF) by helping with concrete and interpersonal tasks. Time perception and management are essential issues among caregivers. However, investigators have not explored this topic in caregivers of people with HF. Objectives: The aim of this study was to describe the perceptions and challenges of the time management experience among caregivers who support the self-care efforts of their relatives with HF. Methods: Adult informal caregivers of patients with HF, taking care of the patient for at least 3 months and without cognitive limitations, were recruited from Spain, Italy, and the Netherlands. Data were collected using semistructured interviews. Maryring's qualitative content analysis strategy with both a deductive and an inductive approach was used for analysis. Results: We enrolled 50 participants (20 Italians, 19 Spanish, and 11 Dutch). Caregivers had a mean (SD) age of 62.8 (12.8) years and were mostly female (84%). They dedicated 31.2 (SD, 21.7) hours per week to providing caring activities for their patients. After extracting 33 codes from their qualitative interview data, we summarized them into 8 categories and identified 4 main themes: (1) time for yourself, (2) house management, (3) time for the patient (dedicated to directing care), and (4) time for own socialization. Conclusion: Caregivers navigate the complexity of time management by balancing dedicated time for supporting patients with HF and their own personal time

Development and psychometric testing of the European Heart Failure Self-Care behaviour scale caregiver version (EHFScB-C)

Background: The European Heart Failure Self-Care Behaviour Scale (EHFScBS) is used worldwide to measure heart failure (HF) patient self-care, but a caregiver version does not exist. Objective: To develop and test the European HF Self-Care Behaviour Scale for Caregivers (EHFScBS-C) in a population of informal caregivers of HF patients. Methods: The EHFScBS-C was derived from the EHFScBS to measure the extent to which caregivers contribute to HF patient self-care. The EHFScBS-C was developed in English and then translated into Italian, Spanish and Dutch, after which it was back-translated. EHFScBS-C data were collected from 193 HF caregivers enrolled in Italy, Spain and the Netherlands. Results: Exploratory factor analysis revealed two factors with supportive fit indices (CFI = 0.990; RMSEA = 0.048): caregivers contributions to HF self-care related to medical issues, and caregivers contributions related to lifestyle. Internal consistency reliability was supported as well (Cronbachs alpha 0.90 for the overall scale). Construct validity was demonstrated with significant correlations with the Caregiver Preparedness Scale. Conclusion and Practice Implications: The EHFScBS-C has adequate validity and reliability for its use in clinical practice and research to measure the extent to which caregivers contribute to HF patient selfcare. The EHFScBS-C can be used in combination with the EHFScBS to conduct dyadic studies. (C) 2021 Elsevier B.V. All rights reserved.Funding Agencies|Heart Failure Association of European Society of Cardiology ESC within the Heart Failure Nurse Research Training Fellowship; Center of Excellence for Nursing Scholarship, Rome, Italy</p

Psychometric Characteristics of the Mutuality Scale in stroke patients and caregivers

Purpose: The Mutuality Scale is composed of 4 theoretically derived factors (love, shared pleasure activities, shared values and reciprocity) but this structure has never been confirmed. Also, research involving the patient’s perspective on the Mutuality Scale is limited. In this study we tested the factorial structure of the Mutuality Scale and its reliability in stroke caregivers and patients. Design and Method: cross-sectional, with a follow up after 15 days for test-retest reliability. 163 stroke caregivers and 248 stroke patients completed the Mutuality Scale. Stroke patients and their caregiver were enrolled in ten rehabilitation hospital across Italy. Mutuality Scale factorial structure was analyzed with Confirmatory Factor Analysis; internal consistency reliability was evaluated with Cronbach’s alpha and model-based internal consistency index; test-retest reliability was evaluated with intraclass correlation coefficient. Results: Confirmatory Factor Analysis supported the four factor structure of Mutuality Scale in its caregiver and patient version (CFI=0.94 and RMSEA 0.06 for both). Cronbach’s alphas and modelbased internal consistency index were > 0.90 and Intraclass Correlation ranges between 0.66 to 0.93 in Mutuality Scale caregiver and patient version. Implication: This study tested the theoretical dimensions of the Mutuality Scale in stroke caregivers and patients. From a scientific and clinical point of view, an assessment of stroke caregiver and patient mutuality would allow dyadic approaches to data analysis and care that account for the non-indipendence between the stroke caregiver and the patien