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Aim: This paper is a report of a study to explore Australian parents' knowledge, beliefs, practices and information sources about fever management and develop a scale to measure parents' fever management practices., Background: Parental fever phobia and overuse of antipyretics to reduce fever continue. No scales to measure parents' fever management practices are available., Method: A community-based, postal survey was carried out in 2005 with 401 Australian parents of well children aged 6 months-5 years. Respondents were recruited through advertising (48.4%), face-to-face (26.4%) and snowball (24.4%) methods. A 33-item instrument was developed; construct and content validity were determined by an expert panel and item reliability by test-retest., Results: Moderate fever (40.0 +/- 1.0 degrees C) was reported to be harmful (88%), causing febrile convulsions (77.7%). Usual practices targeted temperature reduction, antipyretic administration (87.8%), temperature monitoring (52.5%). Fewer evidence-based practices, such as encouraging fluids (49.0%) and light clothing (43.8%), were reported. Positive changes over time (36.4%) included less concern and delayed or reduced antipyretic use. Negative practice changes (22.7%) included greater concern and increased antipyretic use. Medical advice was sought for illness symptoms (48.7%) and high (37.4%) or persistent (41.5%) fevers. Fever management was learnt from doctors, family and friends and working experience, while receiving conflicting information (41.9%) increased concerns and created uncertainty about best practice., Conclusion: Parents need consistent evidence-based information about childhood fever management. The Parental Fever Management Scale requires further testing with different populations and in different cultures and healthcare systems to evaluate its usefulness in nursing practice and research.

Aims: The aim of this study was to explore family members' and ex-patients' perceptions of caring for people who had previously attempted suicide., Background: Suicide is a major public health problem in Taiwan. Official figures demonstrate that suicide was one of the top 10 causes of death in the last eight years, with 18.8 per 100,000 people taking their own lives in 2005. The Taiwanese Government has set targets to reduce this rate. All members of the population play a role in the prevention of suicide, including families and carers of those at risk. Evidence is sparse on the role that families take in caring for members who have been discharged from hospital following a suicide attempt., Methods: Grounded theory using one-to-one tape-recorded interviews were conducted with patients who had just been discharged from hospitals following a suicide attempt (n = 15) and family members (n = 15). Data were analysed using open, axial and selective coding., Results: The core category that emerged was 'Impending burnout', depicting family members' experience of caring for people who had attempted suicide. Other key categories linked to and embraced within this core category were: on guard day and night, maintaining activities of daily living and creating a nurturing environment., Conclusion: Families and carers could use the emergent theory as a guide to caring for people at risk of suicide. Psychiatric nurses could use the theory as a framework to educate family members on enhancing the quality of care provided to this group of people. The theory could go some way towards reducing suicidal attempts and decreasing re-hospitalisation rates., Relevance to Clinical Practice: The finding indicated that family members experienced difficulties when caring for those who had previously attempted suicide. Consequently, nurses have a pivotal role in educating families and carers on preventive strategies before suicidal patients are discharged from hospitals.

Purpose/objectives: To compare treatment protocol adherence, satisfaction, and perceived changes in emotional and functional status between patients with lymphedema with and without cancer using the home-based Flexitouch (Tactile Systems Technology, Inc.) system for lymphedema self-care., Design: Quasi-experimental, pre- and post-test design., Setting: Private homes in the continental United States and Alaska., Sample: 155 community-dwelling individuals with lymphedema: 93 with cancer-related lymphedema and 62 with noncancer-related lymphedema., Methods: A survey was completed before use of the Flexitouch system. Participants received in-home education about device use, safety precautions, and the two-phase therapy protocol. A post-therapy survey was completed during the maintenance phase of the protocol., Main Research Variables: Use of the Flexitouch system, treatment protocol adherence, participant satisfaction, and emotional and functional status., Findings: Participants without cancer were more adherent to the prescribed protocol. Both groups were satisfied with the system, perceived it to be effective, and reported improvement in physical and emotional status. Participants' use of professional manual lymphatic drainage (MLD) therapy, self-MLD, and bandaging declined after they initiated use of the Flexitouch system., Conclusions: Patients using the Flexitouch system were satisfied with the device and perceived it to be beneficial in management of their lymphedema., Implications for Nursing: Patients using the Flexitouch system should be assessed for adherence to the prescribed treatment protocol and use of other self-care treatments. Healthcare professionals should facilitate communication among members of the lymphedema treatment team and the patient when problems are noted.

Background: Capillary whole-blood point-of-care prothrombin-INR (PT-INR) testing at home is an alternative to hospital-based monitoring for patients on lifelong warfarin., Aim: To retrospectively assess the safety and efficacy of home point-of-care testing for children on long-term warfarin., Method: All patients who had been on point-of-care home monitoring for at least 6 months were included in the study. Their warfarin control was assessed while on home monitoring and compared to that achieved in a similar period before changing from hospital monitoring., Results: Thirty-seven patients were studied for a mean of 1.0 year on clinic monitoring and 1.07 years on home monitoring. The clinic monitoring tests were within a therapeutic range for a median 70.0 (inter-quartile range 34.5) and the home monitoring were within range for median 75.0 (inter-quartile range 44.5). There were no major haemorrhagic or thrombotic complications in either group during the study period. Only 2.3% of all tests had an INR greater than 6.0 with no statistical differences seen between the clinic and home monitoring groups., Conclusion: Home point-of-care testing in children on lifelong warfarin is safe, effective and offers a number of advantages to the child and family. Ongoing training and support for the families is essential for this service.

Background: Family caregivers are often responsible for providing significant support to relatives who require palliative care at home. However, evidence suggests that family caregivers have limited information, resources or support to prepare them for such a role. Furthermore, family caregiving can be associated with negative physical, financial and psychosocial outcomes., Purpose: This project sought to examine the utility of a group family caregiver psycho-educational programme focused on preparing primary family caregivers for the role of supporting a relative with advanced cancer at home., Method: The education programme consisted of three consecutive weekly sessions presented in a group format, conducted at six home-based palliative care services across metropolitan and regional Victoria (Australia). Participating caregivers were required to complete a set of self-report questionnaires measuring caregiver competence, preparedness, optimism, rewards, social support, burden and information needs, at three time points: commencement of the programme (T1), upon completion (T2) and 2 weeks later (T3). Caregivers were also asked to report on the relevance, acceptability and content of the programme, as well as any barriers to access., Results: Sixteen education programmes were conducted, with 74 caregivers attending the first session. Forty-four caregivers completed all three data collection sets. Following the intervention, a significant positive effect was found for the following outcomes: preparedness for the caring role, caregiving competence, caregiving rewards and having information needs met from T1 to T2. These improvements were maintained at follow-up (T3). Feedback on the individual sessions and entire programme was favourable and the overwhelming majority of participants reported that the programme had a positive impact on their lives., Conclusions: This study demonstrated that a group education programme to prepare family caregivers for the role of supporting a dying relative at home was accessible, applicable and effective.

Objective: Discuss family caregivers of stroke survivors' changing needs for education and support across the care continuum., Methods: Conceptual review., Results: Stroke is a serious, sudden onset illness requiring care across the care continuum. The focus of care, the individuals primarily responsible for providing that care, and patients' self-care abilities change across care environments. Often family members who provide support also experience changes in their caregiving role. To date, however, interventions for family caregivers have not explicitly considered their changing support needs. Our "Timing It Right" framework highlights family caregivers changing experiences and corresponding support needs across the care continuum. Five different phases of caregiver support are discussed: (1) event/diagnosis; (2) stabilization; (3) preparation; (4) implementation; (5) adaptation. The first two phases occur during acute care, the third occurs during acute care and/or in-patient rehabilitation, and the final two phases occur in the community., Conclusions: Application of this framework has the potential to benefit future intervention efforts by identifying gaps in caregiver education, training, and support., Practice Implications: Recognition of family caregivers changing support needs across the care continuum will assist health care professionals to provide more timely and appropriate support.

Paracetamol is one of the most common medicines administered to children and is available in suppositories, mixtures, drops and tablets. Orally administered paracetamol is more rapidly and completely absorbed and is, in general, more acceptable to children. In Iceland, the most common route of paracetamol administration is per rectum. The purpose of the study was to explore parents' knowledge and usage of paracetamol for 3- to 6-year-old children. Parents (n = 103) of children in four playschools in Reykjavík participated in this survey research. Paracetamol was most commonly administered via suppository. Some parents were unaware of oral forms of paracetamol and had been advised by doctors, nurses or pharmacy staff to use suppositories. This study provides basic information needed to design appropriate parental education in pain and fever management.

A number of different intervention programmes have been described in the literature for caregivers of people with dementia, but the nature of intervention has varied widely. The aim of the present study was to evaluate the efficacy of psychosocial intervention on family caregiver's level of burden and satisfaction, and possible influence of the caregiver's relationship and health and the patient's severity of the disease on the effects of intervention. All persons, 70 years and older, from two districts of a municipality (2721 individuals) who were in receipt of any form of social services were invited to participate in a screening of cognitive decline, and 1656 home visits were made. Those with symptoms of cognitive decline, and having a family caregiver, were invited for a further medical examination. Data were analysed from 308 family caregivers: 153 caregivers who underwent intervention and 155 control caregivers who did not. Repeated measures were carried out 6 and 12 months later. Outcomes were measured using instruments that had been tested for reliability and validity, and all patients were diagnosed according to DSM-IV dementia criteria. Caregivers who underwent the psychosocial intervention (5-week programme and 3-month conversation group) reported significantly lower strain and disappointment after 6 months, and this trend remained after 12 months. Satisfaction, measured in terms of purpose, increased in the intervention group and decreased in the control group. The best effect on caregivers in the intervention group was found early in the progression of dementia and in caregivers with impaired health. These findings emphasize the importance of identifying family caregivers early in the caring process to optimize well-being. This study demonstrates that psychosocial intervention with a clearly defined aim that includes giving information and having a conversation group have significant, positive effects on burden and satisfaction for caregivers of people with dementia.

The information conveyed to patients and families dealing with a health problem such as traumatic brain injury or stroke combines with what they already know to form a new pool of knowledge. The aim of this pilot study was to describe the information needs of family caregivers, their sources of information, their strategies for gathering information, and the impact of the information on their adjustment and their relationship with health professionals. Focus groups were held with close relatives of persons who had sustained a traumatic brain injury or a stroke and with health professionals from various disciplines working with theses clienteles. The information needs of relatives concerned the impact of the person's disabilities on their everyday lives. From the professionals' point of view, the information needs of close relatives concerned the person's disabilities, their coping strategies, and their information sources. Life experience was the main source of knowledge. The results form a basis for recommendations regarding interventions in acute care and rehabilitation.

A qualitative exploratory study investigated the experiences and needs of family carers of persons with enduring mental illness in Ireland. The current mixed-methods secondary study used content analysis and statistical procedures to identify and explore the coping strategies emerging from the original interviews. The majority of family carers reported use of active behavioural coping strategies, sometimes combined with active cognitive or avoidance strategies. The percentage of cares reporting use of active cognitive strategies was the lowest among those whose ill relative lived in their home, and the highest among those whose relative lived independently. Participants with identified active cognitive strategies often reported that their relative was employed or in training. Participants who reported use of avoidance strategies were significantly younger than participants who did not report use of such strategies. The lowest percentage of avoidance strategies was among participants whose ill relative lived independently, whereas the highest was among carers whose relative lived in their home. The findings of this study highlight the importance of a contextual approach to studying coping styles and processes. Further research questions and methodological implications are discussed.

Background: Community mental health nurses (CMHNs) are the backbone of specialist mental health services in the UK. This study evaluated the effects of training CMHNs in a systematic psychosocial intervention (PSI), to help family carers manage behavioural changes in their relative with dementia., Method: One hundred and thirteen family carers received PSI support from a 'trained' (experimental), or a 'usual practice' (control) CMHN. Primary (day-to-day behaviour problems and management) and secondary (carer mood) outcome measures were obtained at baseline, 6, 12 and 18 months. CMHN training and supervision commenced prior to, and continued throughout, the 18-month study., Results: Patient cognition declined in both groups, but problem behaviour reduced in experimental group families. However this effect was associated with the practice of some, not all, CMHNs. Carer management and mood improved with PSI support. In contrast, by 18 months, families supported by conventional CMHNs reported reduced coping resources, increased problem behaviour and their level of depression worsened. Only two CMHNs adhered to the PSI-protocol., Conclusions: Some, but not all, 'trained' CMHNs used the PSI to help family carers reduce behavioural problems. A relatively long but not intensive PSI of 12-18 months was needed to moderate carer mood. Dementia-specific practice arrangements, training and sustained clinical supervision are important for the delivery of effective psychosocial interventions in dementia., (Copyright (c) 2007 John Wiley & Sons, Ltd.)

Aims and Objectives: To identify whether providing a new information leaflet for parents regarding the management of a febrile convulsion was more effective in comparison with standard leaflets., Background: Although information leaflets are frequently recommended within healthcare, their quality is often poor. Furthermore, the evidence regarding the effectiveness of leaflets is inconsistent. Few studies have evaluated the effects of providing leaflets that have been developed to improve their quality. Within the specialty of paediatrics, parents are often unprepared regarding the management of febrile convulsion at home and the provision of supplementary leaflets is recommended, despite limited evidence regarding the effectiveness of this approach. There is also limited evidence regarding whether improving the quality of these leaflets leads to better outcomes, e.g. increasing parents' behavioural knowledge., Design: Double-blind randomized controlled trial., Method: One hundred and twenty-six parents of children hospitalized due to benign febrile convulsion were recruited (May 2000-February 2002). Seventy-one parents were randomized to receive the standard care (control leaflet) and 55 parents received the intervention (new leaflet). Data were collected from parents on discharge immediately prior to receiving the intervention and 7-14 days following the intervention via telephone interview., Results: Parents who received the new leaflet found this to be more reassuring and easier to understand than parents who received the control leaflet. No differences between groups were identified regarding the primary outcome, i.e. behavioural knowledge and most of the secondary outcomes, e.g. perceived confidence, state anxiety and satisfaction with the leaflet., Conclusion: Although this study provides modest support for the effectiveness of providing high-quality leaflets, further research is required to determine the best methods for optimizing the effectiveness of leaflets provided at hospital discharge., Relevance to Clinical Practice: The quality of leaflets may influence some outcomes, e.g. understanding and reassurance with the written information provided; however, additional strategies to inform parents may be necessary.

Behavioral symptoms of Alzheimer's disease, particularly agitation, appear to be a major contributing factor to the emotional distress exhibited by family caregivers. Psychosocial interventions have been shown to reduce caregiver emotional distress, but few studies have examined the efficacy of these interventions with caregivers exposed to high levels of dementia-related behavioral symptoms. The purpose of this study is to test the efficacy of a caregiver skill building intervention in reducing emotional distress to agitated behaviors of care recipients. This study analyzed data from a subgroup of caregivers who participated in a larger randomized clinical trial (N = 295). Data from 143 caregivers of family members with baseline agitated behaviors indicate that the skill building intervention was more effective than an information and support oriented comparison condition in reducing emotional distress over an 18-month period. These findings indicate that dementia caregivers exposed to agitated behaviors can benefit from psychosocial interventions, particularly those aimed at building behavioral management skills.

Aim: To identify parents' knowledge, beliefs, management and sources of information about fever management., Background: Despite numerous studies exploring parents' management of childhood fever; negative beliefs about fever and overuse of antipyretics and health services for mild fevers and self-limiting viral illnesses continue to be reported., Design: Qualitative design using semi-structured interviews and discussions., Method: Fifteen metropolitan parents whose children were aged six months to five years, volunteered to participate in individual interviews or group discussions. Recruitment was through Playgroup Queensland's online newsletter and letters from two childcare centres to all parents. Verbatim and audio data were collected by an experienced moderator using a semi-structured interview guide., Data Analysis: Two transcripts were independently analysed by two researchers; categories, sub-headings and codes were independently developed, crosschecked and found comparable. Remaining transcripts were analysed using developed categories and codes., Results: Fever, determined through behavioural changes, was perceived as 'good', a warning that something was wrong. High fever, reported as 38.0-39.1 degrees C, was considered harmful; it must be prevented or reduced irrespective of concerns about antipyretics. Positive febrile experiences reduced concern about fever. Negative experiences such as febrile convulsions, media reports of harm, not receiving a definitive diagnosis, inaccessibility to regular doctors and receiving conflicting information about fever management increased the concerns. Parents seek information about fever from multiple sources such as doctors, books and other parents., Conclusions: Parents' experiences with and information sources about fever and fever management influenced their knowledge, beliefs and practices. Positive experiences reduce concerns, health service usage and sometimes antipyretic usage. Negative experiences increase concerns, monitoring and antipyretic and health service usage., Relevance to Clinical Practice: Health professionals need to update their fever management knowledge ensuring that it is based on the latest scientific knowledge. They must provide parents of young children with consistent, reliable information preferably before their first child's first febrile episode.

Home safety is a significant problem for caregivers of people with Alzheimer's disease and other dementias. This focus group study is designed to gain insight into caregivers' experiences of managing safety issues and to explore application of the transtheoretical model of health behavior change (TTM) to this problem, toward development of interventions to improve safety care. Caregivers identified safety problems and management strategies, as well as barriers and factors facilitating management, that can help guide the development of interventions. Caregivers described different stages of adopting actions to prevent accidents and injuries consistent with the TTM. The TTM warrants further study for understanding how to help caregivers make changes to promote safe care.

Up to 90% of caregivers report sleep disturbances, particularly congestive heart failure (CHF) caregivers. Sleep disturbances have numerous consequences that can negatively impact a wide domain of outcomes in both the caregiver and the patient for whom they care. Ultimately, these disturbances can lead to caregiver morbidity and CHF patient morbidity, readmission, and mortality. Nurses play a central role in patient education, especially with caregivers. Therefore, nurses can help to educate caregivers on the consequences of stress-related sleep disturbances, which are very prevalent in CHF caregivers.

National Family Caregivers month is a reminder of the invaluable contributions of family caregivers--contributions that are too often unrecognized when addressing the costs of health care. Unpaid caregivers spend a substantial percentage of each week "helping out," often with older relatives, which requires major changes in their work patterns. It is clear that these caregivers may need help balancing their work and caregiving responsibilities, and it is tempting to want to help them by "taking over" some of the seemingly overwhelming tasks they face daily. Yet, it is also important to recognize the ways in which these tasks may enrich caregivers' own quality of life. Through listening to caregivers, nurses and other health care professionals can better understand the embedded values, goals, joys, and disappointments that connect their lives with those for whom they care.

We conducted 16 in-depth interviews with family caregivers of AIDS patients in three rural districts in western Uganda. They were selected from a client visitation list of the home-based care program for AIDS patients, based on volunteer participation. Family caregivers reported huge problems associated with providing the necessary psychological, social, and economic care. They also said that the physical and emotional demands of caregiving are overwhelming daily challenges. Most support to AIDS patients provided by family, friends, and the churches. The study highlights the great burden of caregivers, in sub-Saharan Africa who most often are elderly women and young girls. This study examine, the burden and related health issues of family caregivers, primarily women, for AIDS patients in Uganda. It was part of a broad research project using qualitative methods on family caregiving in the home environment in sub-Saharan Africa. As the requirements for family care giving are often overwhelming for women under the conditions as they exist in Uganda and in other developing countries, it constitutes a gender issue of great importance that has not been appreciated fully in the international literature. Family caregiving is also of international relevance, as HIV/AIDS is a global pandemic of previously unknown proportions. In many poor countries, family caregiving is the most common and often the only care that AIDS patients receive, because clinic-based care often is not available close to home or is not affordable. Therefore, family caregiver support programs to alleviate this burden are essential for all those countries where HIV/AIDS is prevalent. Family caregiver burden encompasses medical, social, and economic issues at the household level, which requires an interdisciplinary approach in order to fully understand and appreciate the different dimensions of the family caregiver burden and its negative impact on the lives of so many women in so many countries.

Aims: This study aimed to examine the effect of an educational intervention on discharge advice given to parents leaving the emergency department with a febrile child., Background: Childhood fever is a common reason to seek emergency care. Many children are discharged from the emergency department with fever as a significant component of their illness; therefore, it is vital that emergency department medical and nursing staff provide accurate and reliable information about childhood fever management., Design: A pre/post-test design was used. The outcome measure was parental advice regarding paediatric fever management and the intervention for the study was an educational intervention for emergency department nursing staff that consisted of two tutorials. Data were collected using structured telephone interviews., Results: Data were collected from 22 families during the pretest period and 18 families during the post-test period. The number of parents leaving the emergency department with no advice decreased by 48% (p = 0.002). Reports of written advice increased by 69.7% (p < 0.001) and there was a 38.4% increase in reports of verbal advice (p = 0.014). Parents leaving the emergency department with both written and verbal advice increased from 0 to 55.6% (p < 0.001). Reports of advice by nursing staff increased by 52% (p < 0.001) and there were significant increases in specific instructions related to oral fluid administration (22.7 vs. 77.8, p = 0.001) and use of antipyretic medications (27.2 vs. 77.8, p = 0.001)., Conclusion: Evidence-based education of emergency nurses improved both the amount and quality of discharge advice for parents of febrile children., Relevance to Clinical Practice: Parents and health care professionals alike need to better understand the physiological benefits of fever and the potential harmful effects of aggressive and often unwarranted treatment of fever.

Purpose: To provide information on evaluation of written educational materials and to illustrate the evaluation of Sickle Cell Disease: A Family Guide (SCDFG) used for children with sickle cell disease (SCD) and their families. A large Valerie Fund Children's Center developed the SCDFG in collaboration with the New Jersey Department of Health and Senior Services, Special Child Health and Early Intervention Services. Two university faculty members and one pediatric nurse practitioner (NP) working in the clinic conducted an evaluation of the effectiveness and usefulness of the SCDFG., Data Sources: Forty-eight caregivers of children with SCD who were using the SCDFG were asked to complete a survey developed by the investigators. The survey was completed during a clinic visit., Conclusions: The SCDFG met the standards for content, organization, layout, linguistics, visuals, readability, and comprehension. Overall, the caregivers were knowledgeable about the cause, signs and symptoms, and what to do during a sickle crisis. More than half the participants reported that they felt confident in managing their child's problems related to SCD. Confidence of the caregivers was positively correlated with their perception that the information in the SCDFG was helpful and easy to understand., Implications for Practice: NPs need to evaluate written educational materials that are used as part of a multifaceted approach to the care of children with chronic illnesses. A planned systematic evaluation provides the NP with information about the efficacy and usefulness of the written educational materials. These materials may help empower children and caregivers to manage their long-term illnesses.

The authors explore an underdeveloped area of health geography by examining information transfer and knowledge acquisition for a health-related social program. Specifically, they discuss the findings of a small-scale utilization-focused evaluation of Canada's Compassionate Care Benefit (CCB). The CCB allows workers who are eligible for employment insurance to leave work to care for family members at end-of-life. Using the findings of 25 interviews with family caregivers, the authors explore their geographies of information transfer and knowledge acquisition. First, however, they introduce their respondent group and provide an overview of their socio-spatial lives as family caregivers. They then examine 3 specific thematic findings: awareness of the CCB, access to information related to the CCB, and the application process. The authors discuss the implications of the findings for the information needs and burdens of family caregivers and for Canadian nursing practice. They also consider directions for future CCB research.

Thirteen percent of Hispanic households provide care to an adult aged 50 or older, but given their dramatic population growth, an increasingly large number of families will soon be placed in a caregiving role. The purpose of this study was to determine whether Hispanic caregivers could be accessed through local provider groups, with the goal of generating interventions to decrease caregiver burden. Study findings raise Anglo nurses' awareness of the need for staff who share the values and language of diverse subgroups. Second, they confirm the presence of male caregivers, sons who alone provide personal care to a parent. Lastly, the effect of empathetic, informal interactions and personal stories in communication with Hispanics cannot be overstated. We believe that our findings are of interest to clinicians who help Hispanic families access community care agencies and, conversely, will help community agencies identify families who need assistance and clinical researchers who are seeking study participants.

Unpaid carers see the Primary Health Care Team as an important source of help, information and support. A pilot Carers' Health Clinic to address the health needs of carers was set up in South West Edinburgh. The Clinic offered carers an assessment of their own health needs and information on a range of support services available to them including referral to a stress management therapist, if appropriate. Although physical health problems identified were mainly minor, the clinic findings indicate that many carers experienced emotional costs which they perceived to have an impact on their health. The Carers' Health Clinic pilot was a successful model, targeting carers who had not previously been in touch with carer support organizations and improving the awareness of carers of their own health needs.

The number of children in the U.K. who are being fed enterally at home is increasing. Feeding by nasogastric or gastrostomy tube may not seem particularly abnormal to nurses who care for sick children. However, the initiation of tube feeding can have a significant impact on both the child and the family. Research related to children with disabilities who have feeding problems is focused around the views of their mothers because they are often the main carers of these children. However, eating is a social activity in our society and tube feeding will have an effect on other members of the family. To provide adequate support, nurses need to understand the nature and scale of the impact that continuing with oral feeding or changing to gastrostomy feeding has on the whole family.

Aim: To investigate general surgical patients' perspectives of the adequacy and appropriateness of their discharge planning., Objectives: To identify any aspects of discharge planning that could be strengthened to assist people in managing their posthospital care and maintaining continuity of care., Background: Appropriate discharge planning is a priority in today's healthcare environment in which patients are discharged 'quicker and sicker', sometimes without home support. Adequate and appropriate discharge planning helps promote health literacy, which has benefits for both patients and their caregivers in helping them manage postsurgical recovery at home., Design: A qualitative, interpretive study was designed in which patients were interviewed at least one week after they returned home from hospital., Methods: Purposeful sampling was used to interview 13 general surgical patients from one of three hospitals (two public and one private) in New South Wales and Queensland, Australia. Data were collected in unstructured interviews and analysed using thematic analysis. Reflective analysis by individual research team members generated preliminary themes, which were then analysed collectively by all members of the research team to achieve consensus on patients' perspectives., Results: Themes included a 'one-size-fits-all' approach to providing discharge information; inconsistent or variable advice from different health professionals; a lack of predischarge assessment of their home and/or work conditions and the need for follow-up assessment of patient and carer needs., Conclusions: The findings of this study illuminate the need for a more individualized approach to discharge planning, taking into account the patient's age, gender, surgical procedure and family and community support for immediate and longer-term nursing follow-up., Relevance to Clinical Practice: Patients would be more adequately prepared for their recovery period at home, by encouraging client-centred, interdisciplinary communication between health practitioners; adopting a flexible, approach to discharge planning which is tailored to individual needs of postsurgical patients, particularly in relation to advice and information related to recovery; and encouraging and supporting adequate health literacy for self-management.

Background: Treatment adherence is a widely recognized problem in health services but understudied in caregiver intervention research. This study examines caregiver sociodemographic and psychological characteristics, patient illness severity, and treatment implementation factors as predictors of caregiver adherence to a skills training intervention to help families manage dementia care problems at home., Methods: The sample consisted of 105 caregivers randomized to the Home Environmental Skill-Building Program at the Philadelphia site of the National Institutes of Health (NIH) Resources for Enhancing Alzheimer's Caregiver Health (REACH I). The intervention, implemented by occupational therapists, consisted of education, problem solving, communication, environmental and task simplification techniques, and home modifications. Adherence was measured by a proportion score representing the percentage of strategies used by participants compared to the total number of strategies prescribed during intervention (Strategy Use)., Results: Regression analysis with intraclass correlation adjustment for interventionist effects revealed that caregivers with better physical health (p <.001), greater treatment exposure (p <.001), more problem areas addressed (p =.012), and for whom more active therapeutic techniques (role play) were used (p =.004) demonstrated greater adherence. Other caregiver characteristics, patient cognitive impairment, and troublesome behaviors were not significantly related to caregiver adherence., Conclusions: Modifiable caregiver and treatment implementation factors, including active engagement of caregivers, were associated with adherence, whereas patient characteristics were not. Caregivers with poor health may be at risk for not benefiting from intervention, suggesting that efforts, including instruction in preventive care and allocating time to attend to their own health care needs, be directed towards improving their health.

Background: Schizophrenia is mainly characterized by chronic psychotic symptoms such as delusions, hallucinations, and negative symptoms such as social withdrawal. These symptoms cause behavior problems, i.e. aggressive behavior violence, or social isolation that affect the patients' lives, and the health status and daily routine of caregivers or family members. Psychological distress or burden of caregivers often results in poor care provided to these patients. Most studies showed that high expressed emotion in the family leads to high a relapse rate of schizophrenia. The psycho-educational program is aimed to provide education about this disorder help the caregivers to deal with the patients' problems more effectively, reduce psychological distress of caregivers, and provide social support for caregivers., Objective: Study the effects of psycho-educational program on knowledge and attitude of schizophrenia on caregivers of schizophrenic patients., Material and Method: The participants completed the one-day psycho-educational program run by a team of psychiatrists in the Department of Psychiatry, Chulalongkorn Memorial Hospital. The psycho-educational program was composed of didactic session on schizophrenia, group discussion, and communication skill building. The participants were evaluated for the knowledge and attitude, before and after the program. The mean scores of knowledge, attitude before and after the program were compared by using paired t-test., Results: Ninety-one caregivers of schizophrenic patients participated into the present study. The results showed that the mean scores of knowledge and attitude before the program were 6.06 (SD = 1.86) and 37.57 (SD = 6.46) and after the program were 6.91 (SD = 3.35), and 29.37 (SD = 15.79), respectively. The scores of knowledge and attitude of caregivers, before and after the program were statistically different. The participants evaluated the program as an interesting and very useful program., Conclusion: Psycho-educational program on schizophrenia increase the knowledge and shape the attitude of caregivers. Therefore, interventions targeting caregivers of schizophrenic patients should result in the successful treatment and rehabilitation of schizophrenic patients.

Objectives: To survey the feeding orientation received during the postnatal period by the parents of cleft babies, as well as the location where they receive the orientation; to identify resources used in feeding; and to assess the correlation of the child's weight with the surgical procedure schedule., Design: During consultation for diagnosis and genetic counseling in a general tertiary hospital, 26 parents of cleft babies born in different hospitals were interviewed based on a semistructured protocol and spontaneous reports., Results: Cleft palate was present in 42.31% (11/26), cleft lip/palate in 50% (13/26), and cleft lip in 7.69% (2/26) of the cases. Feeding orientation was given in maternities to 72% (18/25) and in specific rehabilitation centers to 24% (6/ 25) of the parents. Breast-feeding was encouraged in every case. Nevertheless, other feeding resources were necessary, especially bottles. Surgical procedure delays caused by poor weight gain occurred in 66.7% (12/18)., Conclusions: Neonatal feeding orientation was not systematically given in every case. Because it is an important way to achieve an effective weight gain, educational programs for nonspecialized health professionals, as well as regular pediatric follow-up and specialized multi-professional teams, could improve nutritional intake and could move the schedule for surgical procedures forward. The results also suggest that specific neonatal health care for cleft babies should be part of health policy.

Modernization of the health service has provided patients with an element of choice with health care, which has enabled parents and carers to carry out treatments such as home intravenous therapy (HIVT). Current literature has highlighted the importance of educational programmes for caregivers when undertaking HIVT. This article provides an overview of a training package, developed at Nottingham City Hospital by the children's respiratory nurses. The package is used to assist parents and carers with HIVT for children and young people with respiratory conditions, in particular, cystic fibrosis. The stages of a training programme are discussed, including details of an audit that demonstrated a good response rate in relation to how useful the training pack was for HIVT.

Sleep disturbances in caregivers of patients with congestive heart failure is common. The consequences of sleep disturbances are dire and have potential to seriously impact caregiver health and patient outcomes. Therefore, it is imperative that the health care team, especially nurses, assess and intervene. Basic assessment of caregiver sleep disturbance can be quick and simple and can be performed while assessing the congestive heart failure patient's health. If a more complex sleep disorder is suspected, other assessments can be conducted if time and money permit. The benefits to properly assessing sleep disturbance and subsequent treatment far outweigh the minimal time spent by the health care team or caregiver.

This article is about the trial of a transportable psychoeducation program for family caregivers of older adults with Alzheimer's disease and other dementias that was based on a program developed and previously tested in an academic setting. Family caregivers were recruited by agencies in three states and invited to participate in a randomized trial of this six-session program. Questionnaires were administered prior to randomization and again 5 to 6 months later to assess program effect. A total of 52 caregivers completed both questionnaires (22 were in the wait-list control group). Experimental participants' scores on measures of mastery and distress were significantly better than control participants' scores at follow-up (Time 2 Results for this transported program showed benefits to caregivers com parable to those in the previous trials. The program demonstrated that it could be offered in a variety of settings and that it had benefit for caregivers.

Caregivers (CGs) of stroke survivors assume their role suddenly and with little preparation. Negative emotions are common, persist over time, and are related to other negative outcomes. This pilot study, guided by a coping model, examined the efficacy and durability of a caregiver problem-solving intervention (CPSI) on CG and stroke survivor outcomes. Additional aims included assessment of feasibility issues and reliability and sensitivity of the study measures. The nonrandom sample of 15 stroke CGs was matched on depression and demographics with a comparison group. The CPSI started during acute rehabilitation and continued through 2 months after discharge. Parametric and nonparametric tests were used to assess achievement of the aims. CG depression, anxiety, preparedness, and survivor motor function improved significantly in the intervention group over time. Burden, life changes, and taking care of CG's own needs did not change significantly. CPSI group CG depression significantly improved compared with the matched group. The improvement in outcomes for the CPSI group supports further testing of the intervention with a large sample.

Aim and Objectives: The aim of this study was to examine the content of nursing documentation with a focus on professional support for next of kin (NoK) of patients receiving chronic haemodialysis treatment., Background: Professional support in nursing focuses on promotion, maintenance and restoration of health and prevention of illness., Design: The study had a descriptive design and qualitative content analysis was used to search for themes based on descriptions contained in the collected nursing documentation., Methods: The total number of nursing records of patients receiving chronic haemodialysis treatment (n = 50) for the 5-year period 1998-2002 was included. All nursing documentation was systematic in accordance with the VIPS-documentation model., Results: The professional support could be described within the framework of three themes: to explore NoK's supportive resources, to enable NoK' readiness in caring for the patient and to co-operate with NoK in the care of the patient in the home, captured by the core theme which described the professional support as a continuous process., Conclusions: Next of kin are a supportive resource in the nursing care of patients receiving chronic haemodialysis treatment and professional support for NoK focuses on planning their participation in the care of patients in the home., Relevance to Clinical Practice: Professional support for NoK should be documented in family focused nursing diagnoses, which would make it possible to search for different types of support. Future research might explore nurses' or NoK's views on carer support.

Background: The majority of older persons in Lebanon live with their family, which provides the help and care required when their relative is functionally impaired. Knowing that taking care of an older impaired relative is considered a source of enrichment for the caregiver and an act of gratitude towards the older person in Lebanon. However, there are few formal resources to support these families. This study is informed by a theoretical framework of stress., Objective: Identify the dimensions of the caring context related to the health of Lebanese family caregivers living with an older impaired relative., Design: Exploratory correlational study., Participants: Convenience sample (N=319) drawn from all the regions of Lebanon according to predetermined quotas on the basis of relative demographic weight and socio-economic class. The inclusion criteria are: aged 18 years or over; primary caregiver; provided help with at least one ADL or IADL once a week; lived with the older impaired person. 13.5% refused to participate in the study. The caregivers recruited were female (84%), adult children (48%) or spouses (22.6%) with a mean age of 46 years. Almost half of them reported a post-compulsory level of education and a low monthly household income and no medical coverage for 68% of them., Methods: The data were collected during a face-to-face interviews with the caregivers in their homes., Results: The results from regression analyses indicate that the degree of functional impairment, the frequency of depressive and disruptive behaviours of cared-for relative are linked to at least one of three caregiver health indicators (p<.01). Also, caregiver cognitive appraisal of these stressors is associated with either role strain or feeling of helplessness (p<.05). The informal emotional support received by caregivers is positively related to well-being (p<.001), whereas interpersonal conflicts with family and friends diminish caregiver well-being and increase role strain (p<.001). Sufficiency of emotional support received is negatively associated with role strain (p<.001)., Conclusion: Many stressors proved associated with one or other of the health indicators under study and the resources emerged as significant factors related to caregiver's health.

Aims and Objectives: The purpose of this article is to describe the problem-solving abilities of Hong Kong family carers looking after a stroke patients at home and report the relationships between their perceived problem-solving abilities with their depression level, general health status, and the functional recovery of stroke patients., Background: Previous research on supportive interventions for caregiving in stroke care suggests that enhancing carers' problem-solving abilities is useful. Nevertheless, not much is known about the relationship between carers' problem-solving abilities and their physical and psychosocial health and there is notably little work that has been done with the Chinese population., Design: A cross-sectional and correlational design was used., Methods: A convenience sample of 70 family carers, who were the main carers of stroke patients at home, during the first three months poststroke was recruited to complete a self-report questionnaire., Result: Significant correlations were found between the family carers' global perceived problem-solving abilities and higher level of depressive symptoms (r = 0.35, P = 0.01) and poorer perceived health (r = 0.50, P = 0.01) as measured using the Center for Epidemiological Studies - Depression Scale and General Health Questionnaire. Among the three subscales of the Problem-Solving Inventory, problem-solving confidence showed the highest correlation with these variables. The functional ability of the stroke patients as measured using the Modified Barthel Index (MBI) was not associated with any variables., Conclusion: Findings of this study suggest that perception of confidence is a key factor in appraisal of problem-solving among Chinese family carers, which raises questions for future research about the impact of cultural influences on designing and measuring interventions., Relevance to Clinical Practice: The study has implications for nursing and health care practice and for developing interventions targeted at building self-confidence among Chinese carers.

Although the vital role of informal carers has been acknowledged in government policy documents in the UK, the information needs of informal carers are not well documented. There is also uncertainty about where carers get their information from and whether they are satisfied with the information they receive. This study aimed to examine the information needs and sources of information for informal carers in the acute cancer setting; the informal carers of a sample of women treated for breast cancer. Both quantitative and qualitative data were collected from semi-structured interviews with 50 informal carers. Measures of information needs and sources were administered in addition to an in-depth exploration of information needs. The priority information needs of carers related to cure, spread of disease and treatments, a similar profile to that found for women with breast cancer in previous work. The main source of information for carers was the person they were caring for, although written information was also valued. Health professionals need to ensure that patients are well informed so that patients can provide information for carers and also need to take advantage of any opportunities to directly assess the information needs of carers to enable them to be more effective in their caring role.

The provision of home care services is a key component in avoiding inappropriate admission of older people to institutional care and preventing delayed discharge from hospital. However, there is a growing problem of retention of home care workers (HCWs), creating problems for delivering this increasingly essential service. The present study was based in a health and social services trust in Northern Ireland, and was designed to explore the growing problem of retention of HCWs from their own perspective. The cross-sectional survey design used a convenience sample and questionnaires were completed by 45 HCWs (response rate = 45 of 147, 31%). Responses to most questions were on five-point ordinal scales. Focus groups in which 12 HCWs participated were used to explore emerging themes. The variables studied were HCWs' perspectives on: (1) reasons for considering leaving; (2) working hours; (3) supervision and support, and qualifications and training; (4) workload pressures; (5) client attitudes; (6) pay; and (7) job satisfaction. The main reasons given by HCWs for dissatisfaction and considering leaving were (in rank order): (1) irregular and antisocial hours; (2) lack of management support; and (3) workload pressures. Commitment to caring seemed to be the reason why pay did not feature more highly for those who did not leave. Home care workers are being required to provide care for people with evermore-complex health and social care needs, and in an environment increasingly regulated in terms of quality and risk. This makes it an increasingly demanding job, which does not seem to be recognised in the training and working conditions of HCWs. The most significant factors identified give scope for service managers to improve the retention of HCWs.

Objectives: To determine the expressed needs of persons with traumatic brain injury (TBI) and their primary family caregivers., Design: Semistructured interviews with content-analytic techniques to identify respondents' needs., Participants: Eighty persons with TBI, with an average time since their most severe TBI of 5.8 years, and 85 primary support persons., Results: Respondents described their needs via phases that paralleled transitions in settings, treatments, and responsibilities (ie, acute care, in-patient rehabilitation, return home, and living in the community). Prominent themes during in-patient phases included provider quality, emotional support, and understanding the injuries. Prominent themes during the latter 2 phases included guidance, life planning, community integration, and behavioral and emotional issues., Conclusions: Participants reported insufficient education and preparation for the future. Current methods of identifying needs may not be based on these populations' perceptions, and often miss the natural divisions of needs that occur over the course of treatment and rehabilitation. To meet their needs, services must be responsive to changes in needs over time, accessible to consumers of services for as long as they are required, and designed to be directed and customized by users.

Tonsillectomy is a common surgical procedure usually associated with moderate to severe pain. Although self-report is the gold standard for pain assessment, researchers have not studied young children at home with self-report measures. The purpose of this study was to describe the patterns of self-reported pain intensity and analgesic administration in 3- to 7-year-old children undergoing tonsillectomy during the operative day in the hospital and the first 2 postoperative days at home in Iceland. As part of a larger study, 68 children undergoing tonsillectomy were taught to use the Wong-Baker FACES Pain Rating Scale. Pain intensity scores and data about administration of analgesics were collected from children, the medical record, and the parents over a 3-day period. Children received primarily acetaminophen or acetaminophen with codeine in the hospital. At home, 99% of doses administered were acetaminophen only. Most doses were administered rectally. Forty percent of children received 24-hour therapeutic doses in the hospital. Only 10% received a 24-hour therapeutic dose at home despite significant pain scores of 4 or 5 persisting through the second postoperative day. Younger children were less likely to receive acetaminophen with codeine. In the hospital, children with pain intensity scores of 4 or 5 received prescribed morphine only 13% of the time. Children experienced clinically significant pain through the second postoperative day and will probably require a change in protocol to provide more aggressive pain management earlier. This study extends to younger children the research evidence that current pain protocols are inadequate.

The objective of this study was to understand the following: (1) the specific care needs of geriatric hip fracture patients; (2) the level of care difficulty during the transition period following discharge; and (3) the correlation amongst demographics, the physical function status of the elderly, and care needs. Purposive sampling was used, and a total of 71 hip fracture cases and their caregivers were selected. A survey was carried out to collect data just before discharge and one week following discharge. Statistical methods included descriptive statistics, correlation analysis, one-way ANOVA, and a paired t-test. Results were as follows: Most geriatric patients depended upon care from family members before discharge, with an average physical function status score of 6.99 (0 to 18) that improved significantly after one week to 10.27; paired t = -7.956 (p < .000). The mean age of primary caregivers was 51.72 years old (SD = 14.05). Most caregivers (47, or 66.2%) were female. The relationship between elderly participants and their primary caregiver was predominantly that of husband and wife (22 people; 31.0%). Participant care needs identified included return visit assistance, awareness of safety at all times, assistance with cleaning and maintaining living quarters, and so on. Caring tasks that were identified as more difficult for the primary caregivers includes providing stair climbing assistance, emotional problems management assistance, walking training assistance, rehabilitation assistance, and emergency disease management assistance. The care needs of the elderly in this study and level of execution difficulty for caregivers was found to be negatively related to the physical function status of the elderly. The study results suggest that providing patient-related home care knowledge to primary caregivers prior to discharge from the hospital and enhancement of the social support system are both needed.

This article discusses the pilot test of a psychoeducational intervention designed to improve the care skills, self-health skills, and resource-acquisition skills of caregivers of adults with Parkinson's disease. It describes the intervention and discusses specific feasibility issues explored in the pilot test as well as the modifications made in an ongoing randomized trial as a result of the pilot test. Recommendations for researchers who conduct interventions with older persons in community-based settings are included.

Background: Out-of-hospital cardiac arrest occurs at home in 65-80% of cases and is often witnessed. We designed a study to explore the feasibility of a home defibrillation program (a) evaluating the retention of cardiopulmonary resuscitation and automated external defibrillators (AED) use skills (BLSD) (b) assessing the impact on anxiety, depression, and quality of life and (c) recording the critical issues emerging from program implementation., Methods: Thirty-three post-myocardial infarction patients and their 56 relatives received BLSD training and an AED. Assessment of BLSD skills, levels of anxiety, and depression and quality of life were scheduled every 3 months for 1 year or until a common stopping date., Results: Overall BLSD score was 26 +/- 3 at baseline vs. 22 +/- 5 at 3 months (P < .0001), 21 +/- 6 at 6 months (P < .0001), 22 +/- 4 at 9 months (P < .0001) and 23 +/- 5 at 12 months (P = .001). Conversely, the BLSD component AED use" remained stable throughout the study. Quality of life, anxiety, and depression scores remained constant. Compliance to BLSD retraining sessions and AEDs checks decreased over time and was influenced by a concomitant clinical appointment., Conclusions: BLSD performance of families of post-myocardial infarction patients decreases over time, even though the ability to operate AEDs appears to be the least affected component. Compliance with retraining sessions and AED checks declines over time and is improved if they are combined with clinical appointments. The implementation of a home defibrillation program does not affect anxiety, depression, or the quality of life.

Objective: To assess household practices that can affect neonatal health, from the perspective of caregivers and health workers; to identify signs in neonates leading either to recognition of illness or health-care seeking; and to ascertain the proportion of caregivers who recognize the individual items of the integrated management of neonatal and childhood illnesses (IMNCI) programme., Methods: The study was carried out in a rural community in Sarojininagar Block, Uttar Pradesh, India, using qualitative and quantitative research designs. Study participants were mothers, grandmothers, grandfathers, fathers or "nannies" (other female relatives) caring for infants younger than 6 months of age and recognized health-care providers serving the area. Focus group discussions (n = 7), key informant interviews (n = 35) and structured interviews (n = 210) were conducted with these participants., Findings: Many household practices were observed which could adversely affect maternal and neonatal health. Among 200 caregivers, 70.5% reported home deliveries conducted by local untrained nurses or relatives, and most mothers initiated breastfeeding only on day 3. More than half of the caregivers recognized fever, irritability, weakness, abdominal distension/vomiting, slow breathing and diarrhoea as danger signs in neonates. Seventy-nine (39.5%) of the caregivers had seen a sick neonate in the family in the past 2 years, with 30.38% in whom illness manifested as continuous crying. Health care was sought for 46 (23%) neonates. Traditional medicines were used for treatment of bulging fontanelle, chest in-drawing and rapid breathing., Conclusion: Because there is no universal recognition of danger signs in neonates, and potentially harmful antenatal and birthing practices are followed, there is a need to give priority to implementing IMNCI, and possible incorporation of continuous crying as an additional danger sign.

Psychological abuse of elders is a growing but hidden problem. This study attempted to determine whether caregivers psychologically abuse their elderly care recipients and identify risk factors contributing to such abuse. Ninety-two caregivers completed this study. The Demographic Sheet, the Caregiver Psychological Elder Abuse Behavior scale (CPEAB), and the Caregiver's Burden Scale were used to collect data. The CPEAB scores for caregivers of the elderly were 20 to 51 (mean 30.45 +/- 7.03). The level of abusive behavior was positively associated with gender, education level, and caregiver's burden and negatively correlated with age (P < .01-.05), suggesting that female caregivers, caregivers with higher levels of education, and caregivers with high burdens demonstrated more severe psychologically abusive behavior. Burden and age accounted for 25.9% of the variance for abusive behaviors. This study provides preliminary data estimating caregiver psychologically abusive behavior and its related risk factors. Analytical results provide important information for medical and social interventions and policies for improving the quality of life of elderly people.