Coping and well-being in caregivers of people with Parkinson's disease

Deposited with permission of the author. © 2011 Dr. Siok Bee TanBackground and Purpose: The need to provide care for people with Parkinson’s disease (PD) will increase with the extended life expectancy of Singaporeans. Caring for people with PD in their own homes for as long as possible is argued to provide care recipients with psychosocial benefits as well as benefiting the community by delaying institutionalisation. The aims of this study were to profile the PD caregiving experience and to identify the types of coping strategies used by caregivers. Factors that affect caregiver well-being were also explored to evaluate the types of interventions and support that might facilitate the care of people with PD. Methods: Guided by the theoretical framework of Lazarus’ cognitive theory of stress and coping, a mixed method study was designed. In Phase One, a cross-sectional survey of 94 caregivers was used to generate an overview of coping and quality of life of caregivers caring for care recipients with varying stages of PD. In Phase Two, 21 caregivers recruited from the first phase through a purposive stratified sampling technique were interviewed for a deeper understanding of caregiver experiences. Results: The convergence of the quantitative and qualitative data obtained from this research revealed a complex and challenging range of biopsychosocial issues for caregivers. When PD disease severity increased, most caregivers experienced an increase in caregiver burden and a reduction in well-being. The mental health of caregivers was more affected than their physical health. Caregivers reported being frustrated with care recipient apathy when they did not cooperate with them. Although there is a need to provide physical care for people with PD, caregivers often reported providing care recipients with substantial emotional support. Most caregivers adopted adaptive coping strategies. However, the use of either adaptive or maldaptive coping strategies was associated with an increase in caregiver burden. Many caregivers reported that it was the responsibility of the health care system to provide adequate financial support and integrated PD services. Conclusion: This investigation revealed that caregivers used predominately adaptive coping strategies and the use of maladaptive coping strategies was negatively associated with caregiver well-being. Caregiver burden had the highest impact on emotional well-being. The findings from this study inform future research on the caregiver experience and in planning appropriate and effective multidisciplinary interventions that support caregivers throughout the stages of Parkinson’s disease. Recommendations: The findings of this study inform future research on caregiving as well as the development of supportive interventions for caregivers of people with Parkinson’s disease in Singapore

The Effects of Parkinson's Disease on Caregivers and People with Parkinson's Disease: A Literature Review

Parkinson's disease (PD) is a complex, slowly progressive, neurodegenerative, neurological condition characterised by a wide range of motor problems such as movement disorders, issues with gait and balance, and difficulty with swallowing and speech. In addition, sufferers also experience non-motor symptoms such as disorder of sleep, postural hypotension, mood alterations, lethargy, and cognitive dysfunction. As PD progresses to an advanced stage, people experience periods of debilitating physical and neurological problems and their caregivers face increasing complexity of care. Many people with PD require the support of a caregiver to attend to activities of daily living. This paper will review the literature on the effects of Parkinson's disease on both the patient and caregiver. Findings highlight the progressive nature of the disease affecting both functional and affective domains, and the need for caregiver support to enable the delivery of quality of care to this group throughout the disease trajectory

Nasogastric tube placement confirmation: where we are and where we should be heading

Background: Insertion of a tube via the nasal passage is a common procedure which has been practiced for many years. There are various ways to assess the position of the nasogastric tube (NGT). Objectives: The objective of this study was to discuss the advantages and limitations of each method of NGT placement confirmation, to identify gaps in literature, and provide suggestions for future research. Methods: A search was performed with Pubmed, CINAHL, and Embase. The following keywords were used: “nasogastric,” “tube,” “placement,” “insertion,” and “measurement.” The results were narrowed down to those with full text available, published in the English language, those published within the last 10 years, and those studies done in the adult population. The reference lists of those articles were also referred to and relevant articles were retrieved. A final 26 relevant articles were included in this review, including six that were published more than 10 years ago but still relevant in this review. Results: A method to confirm NGT placement that is accurate, affordable, does not require gastric aspirates, and is able to be used not only upon insertion but also at regular intervals is lacking. Conclusions: This article provides a summary of the different methods of NGT placement confirmation and discusses their advantages and limitations. Gaps in literature and suggestions for future research were also deliberated

Promoting research competence: introduction of the nursing research immersion program in Singapore General Hospital

Individual, organisational and environmental factors play an significant role in developing and promoting research utilisation among nurses. Building a strong research foundation is important for the future of nursing profession. Research utilisation among newly graduated registered nurses has been reportedly to be low in previous population-based longitudinal studies. Historically, nurses find it difficult to understand the value of a nursing research in the course of their clinical practice therefore a more creative and interactive strategies (experiential learning) are needed to make research relevant to clinical practice. This article describes the efforts of a large teaching hospital in Singapore in promoting and building research competence among nurses in the clinical care setting. An immersion program similar to a research internship offers an in-depth and experiential learning experience. It allows students to learn a new knowledge and skills by being completely immersed and engaged in the prescribed activity. The goal of the immersion program is to develop research skills through active participation in the research process and to develop novice nurses’ ability to implement and evaluate evidence-based project that aimed to improve treatment outcomes of patients. An immersion program such as the one described in this article provides a strategy to promote a culture of evidence-based practice. The experiential knowledge gained through this type of program may advance the nursing profession

HLA association in Singapore children with Grave's disease

Metabolism: Clinical and Experimental376518-519META

Health-Related Quality of Life of Caregivers of People with Parkinson's Disease in Singapore

Introduction: To investigate the health-related quality of life (HRQoL) of caregivers for people with Parkinson's disease (PD) living in Singapore. Methods: A face-to-face survey was conducted with a cross-section of caregivers for people with PD. The caregivers were recruited from a PD clinic at an acute tertiary hospital in Singapore and from the members of the Singapore Parkinson's Disease Society. HRQoL was quantified using the SF-36v2® Health Survey, an internationally validated multi-purpose short-form health survey. Results: Ninety-four caregivers completed the survey (a response rate of 57.3%). The respondents were all above 21 years old, with most falling in the 51 and >61 years age range. Seventy-four of the respondents (78.7%) were female. As a whole, the caregivers scored lower in all 6 health domains compared to the general population (adjusted for age, gender and ethnic group) in Singapore. The were significant differences for the “Role Physical” and the “Role Emotional” domains, at 3.9 and 3.3 respectively. Caregivers had a much lower mental component summary (-2.4) when compared to the physical component summary (-1.6). Conclusion: It is important to identify the factors that influence the HRQoL of caregivers so that policies can be developed to lower the burden of PD on caregivers. Assessing the well-being of caregivers may help to identify individuals at risk. The well-being of caregivers has the potential to influence quality of life of people with PD