Exploring factors associated with family caregivers' preparedness to care for an older family member together with home care nurses : an analysis in a Swiss urban area

Introduction: Home-dwelling older people with chronic diseases often need the support of informal and formal caregivers in order to continue living at home. Family members, however, need to be willing and prepared for caregiving together with home care nurses. Objectives: The purpose of this study was to explore factors associated with family caregivers’ preparedness to care for older home-dwelling adults who also receive home care nursing services. Methods: For this cross-sectional correlational study, a structured questionnaire was sent to family caregivers of adults aged 65 years or older receiving services from a community care agency. A total of 243 participants returned the questionnaire, of which 199 could be analyzed. Results: The stepwise backward regression model explained 29.1% of the variance of family caregivers’ preparedness. Mutuality was the most strongly associated factor with family caregivers’ preparedness whereas professional involvement of family caregiver in care process was important as well. Care intensity showed no significant impact. Conclusion: Nurses should support the whole family emotionally, and appreciate, admire, reinforce, and respect the caregivers’ situation. Home care nurses need to invest in helping families to find solutions, to strengthen their relationships between family members and the older person dwelling at home

Effects of high-fidelity simulation on self-efficacy in undergraduate nursing education regarding family systems care and early palliative care

Objective: Family systems care and palliative care are main topics in nursing education and practice. Self-efficacy of undergraduate nursing students is strengthened by high-fidelity simulation. The aim of this study was to explore the effects of high-fidelity simulation on the self-efficacy of undergraduate nursing students regarding family systems care and early palliative care in an adult setting. Methods: A quasi-experimental study design with repeated measures was conducted. Self-Efficacy was measured using the Family Nursing Practice Scale (FNPS) and the Self-Efficacy-Subscale of the Bonner Palliativwissenstest (BPW) before the start of the theoretical family systems care and palliative care courses (t1), after completion of the courses (t2), immediately after high-fidelity simulation (t3) and 3 months after high-fidelity simulation (t4). A linear mixed model was performed to evaluate the difference of self-efficacy between the times of measurement. Results: A total of 46 undergraduate nursing students participated in the study. There were statistically significant differences regarding the FNPS between t1 and t3 (p = .0019) as well as t1 and t4 (p = .0198), and regarding the BPW between t1 and t3 (p ≤ .0001), t1 and t4 (p = .0012), as well as t2 and t3 (p = .0112). Between the other times of measurement, no statistically significant differences were found. Conclusions: High-fidelity simulation in combination with traditional learning methods can have a short- and long-term effect on undergraduate nursing students’ self-efficacy regarding family systems care and early palliative care in hospitalized adult patients

Pflegende im Teufelskreis zwischen steigenden Erwartungen und Personalmangel?

Im Rahmen einer Zweitanalyse einer repräsentativen Umfrage unter Pflegenden im Kanton Bern konnten Zusammenhänge zwischen verschiedenen Determinanten der Arbeitssituation und der Pflegequalität in Spitälern untersucht werden. Die gewonnen empirischen Erkenntnisse bekräftigen einerseits die bereits anhand internationaler Studien belegten Einsichten, dass für eine qualitativ gute Pflege eine ausreichende Personalbelegung notwendig ist. Andererseits lädt die ebenfalls nachweisbare grosse Bedeutung eines wahrgenommenen Konfliktes zwischen Arbeitsrealität und Überzeugung zu einer weiterführenden Interpretation der gefundenen Resultate ein. Vor dem Hintergrund der Anomietheorie von Robert K. Merton können die Ergebnisse so gedeutet werden, dass Pflegende unter einer Spannung zwischen den ihnen zur Verfügung stehenden Mitteln und ihren Zielen stehen und Wege suchen, diese Spannung zu verringern. Möglichkeiten dazu bieten sich ihnen beispielsweise in der von rund zwei Dritteln der Pflegenden gewählten Teilzeitarbeit oder in einer Förderung der eigenen Professionalität. Solche Reaktionen führen aber, wie dies mit Giddens Strukturationstheorie postuliert werden kann, zu nicht intendierten Nebenfolgen. Konkret können sich durch Teilzeitarbeit und Professionalisierung im Sinne solcher Nebenfolgen der Arbeitsaufwand und die Erwartungen der Pflegenden erhöhen. Dadurch entsteht die Gefahr eines Teufelskreises zwischen steigenden Erwartungen und Personalmangel. Diese wird von Tendenzen und Entwicklungen im Rahmen einer so genannten Gesundheitsgesellschaft weiter akzentuiert. So wird der Erwartungsdruck an Pflegende auch von PatientInnenseite grösser und im Rahmen demographischer Veränderungen ist mit einer weiteren Zunahme des gesamtgesellschaftlichen Pflegeaufwandes zu rechnen. Angesichts der grossen Bedeutung des Pflegebereichs innerhalb der Gesundheitsversorgung verdient die Arbeitssituation der Pflegenden auch im Hinblick auf die Sicherstellung einer guten Betreuungsqualität gerade in Zeiten des Wandels Beachtung.

An integrative review on family caregivers’ involvement in care of home-dwelling elderly

Often family members provide care-giving, which allows older adults to remain in their homes. With declining health and increasing frailty, care-giving of elderly people becomes a task of family caregivers (FC) in conjunction with home care nurses. It has been shown in both acute care settings and long-term care facilities that family members prefer to be involved in decision-making and care planning for their next of kin. Therefore, an integrative review was conducted to explore the body of knowledge of FCs' involvement in home-care settings from the FCs' perspective. CINAHL, PubMed, and Cochrane databases was searched with the terms family caregiver, involvement, home care, and community dwelling. Studies written in German or English between 1996 and 2017 focusing on FCs' caring for home-dwelling older adults together with home care nurses were included and critically appraised. The extracted findings were analysed with concept analysis method. Twenty-six studies were included and five themes were identified. Four themes formed the basis of assistance towards family caregivers by nurses and included "relationship building with professionals," "negotiating with professional care," "being professionally supported," and "managing role expectations and knowledge sharing". The fifth theme, "working together" described the mutual care for the care recipient. Although the first four themes were consistent with a pre-existing conceptual model by Sims-Gould and Marin-Matthews (2010), the fifth required an expansion of the model with an additional contribution "collaborative practice". The findings illustrate that involvement in care is an interactional process, which provides the basis for collaborative practices with the home care nurses for family caregivers. Family members often want to be part of the healthcare team, and nurses need contextual factors that allow providing their full range of skills and knowledge to involve family caregivers accordingly

Pflegeauszeit und deren beeinflussenden Faktoren aus der Perspektive der Familienmitglieder, die eine ältere Person zu Hause betreuen und pflegen : eine Querschnittsstudie

Die Studie hatte zum Ziel die Inanspruchnahme einer Pflegeauszeit von Familienmitgliedern zu beschreiben, die eine ältere Person zu Hause betreuen und pflegen, und mittels einer logistischen Regressionsanalyse zu untersuchen. Von insgesamt 243 Familienmitgliedern nahmen 158 eine, 68 keine Auszeit und 17 machten keine Angaben. Rund 30 % der Varianz der Auszeit konnte mit Hilfe der Prädiktoren wie demographischen Angaben, Pflegebereitschaft, Zusammengehörigkeitsgefühl und Involviert sein in die professionelle Pflege erklärt werden. Familienmitglieder, die eine Frau pflegten, und die meistgenannten Aktivitäten während einer Auszeit wie Ferien und Hobby erwiesen sich neben dem sich vom Schlafmangel erholen als signifikante Prädiktoren im Modell