Family Involvement in Adult Chronic Disease Care: Reviewing the Systematic Reviews.

Health care providers, policy makers, and investigators are dependent upon the quality and accuracy of published research findings to inform and guide future practice and research in their field. Systematic reviews, the synthesis of outcomes across studies are increasingly more common in the family literature; however, published review reports often lack information on strategies reviewers used to insure dependability of findings, and minimize methodological bias in the review. In this article, we summarize findings from systematic reviews of interventions and outcomes from family involvement in adult chronic disease care published between 2007 and 2016.

Adapters, strugglers, and case managers: a typology of spouse caregivers.

Although family home care problems are frequently described in the health care literature, the ways in which families and other informal caregivers manage those problems are not often addressed. We conducted a descriptive analysis of interviews in which spouses caring for a partner with Alzheimer's or Parkinson's disease were asked to describe difficult home care problems and how they managed those problems. Analysis of these interviews indicated three recurring management styles.

Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions: a systematic review and meta-analysis.

Background: Changes in federal health policy are providing more access to medical care for persons with chronic disease. Providing quality care may require a team approach, which the American College of Physicians calls the "medical home." One new model may involve nurse-managed protocols.

Do nurse-led skill training interventions affect informal caregivers' out-of-pocket expenditures?

Purpose Of The Study: This paper is a report of a study of the Assistance, Support, and Self-health Initiated through Skill Training (ASSIST) randomized control trial. The aim of this paper is to understand whether participating in ASSIST significantly changed the out-of-pocket (OOP) costs for family caregivers of Alzheimer's disease (AD) or Parkinson's disease (PD) patients.

Design And Methods: Secondary analysis of randomized control trial data, calculating average treatment effects of the intervention on OOP costs.

Advances in mediation analysis can facilitate nursing research.

Background: Two recent advances in the statistical methods for testing hypotheses about mediation effects are important for nursing science. First, bootstrap sampling distributions provide more accurate tests of hypotheses about mediated effects. Second, methods for testing statistical hypotheses about subgroup differences in mediation models (moderated mediation) are now well developed.

The nature and scope of stressful spousal caregiving relationships.

The caregiving literature provides compelling evidence that caregiving burden and depressive symptoms are linked with stressful care relationships, however, relational difficulties around caregiving are seldom described in the literature. This article presents findings from content analysis of baseline interviews with 40 Alzheimer's disease (AD) and Parkinson's disease (PD) spousal caregivers enrolled in a home care skill-training trial who identified their care relationship as a source of care burden. Disappointment and sadness about the loss of the relationship; tension within the relationship; and care decision conflicts within the relationship were recurrent themes of relational stress in caregiving.

Deciding to institutionalize: why do family members cease caregiving at home?

The primary purpose of this secondary analysis was to identify common themes from the statements of caregivers who ultimately decided to institutionalize their relative with Alzheimer or Parkinson disease. Content analysis of transcripts from caregivers (n=11) who institutionalized their relative during their participation in a caregiver intervention study was performed. Two categories identified from the caregivers' stories were anticipating the inevitable and reaching the limit.

Lessons learned from a Parkinson's disease caregiver intervention pilot study.

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.

Differential attrition in a caregiver skill training trial.

Participant attrition in randomized trials can reduce statistical power and bias outcomes. However, elective withdrawals are seldom discussed in trial reports. We examined factors associated with elective withdrawals for the first 131 Alzheimer's disease (AD) and Parkinson's disease (PD) caregiver participants that entered Project ASSIST (Assistance, Support and Self-health Initiated through Skill Training), an on-going trial of caregiver skill training interventions.

Caring for family with Alzheimer's disease and Parkinson's disease: needs, challenges and satisfaction.

A convenience sample of 40 family members caring for an individual with either Alzheimer's disease (AD) or Parkinson's disease (PD) completed the Caregiver Assistance Measure (CAM) to identify the types of assistance that would be most helpful in caring for a family member at home. The CAM measures three categories or types of assistance: care knowledge and skills, self-care, and resource acquisition. Caregivers also completed open-ended questions about the difficulties and the satisfactions of caregiving.

Participant-centered adaptations in caregiver trials: strategies for managing confounds.

Background: Randomized trials have been criticized for being more protocol than participant-centered, with concerns raised about higher subject attrition and limited generalizability under controlled conditions. Informal caregivers are similar to other participants in community-based trials: many are unlikely to remain in a trial without procedural adaptations to meet some of their needs.

Purpose: This article discusses design and statistical strategies for tracking potential confounds associated with 3 participant-centered adaptations that may be made in community-based caregiver trials: tailoring multi-component interventions, using interpersonal contacts for participant maintenance, and non-blinding of trial participants.

Nosocomial urinary tract infection: nursing-sensitive quality indicator in a Thai hospital.

The purposes of this study were to examine relationships among 3 of the American Nurses Association's 10 nursing-sensitive quality indicators: nursing hours per patient day, percentage of RNs, and nosocomial urinary tract infection (NUTI), and to identify the best predictor of NUTI in a hospital in Thailand. The results showed a negative relationship between nursing hours per patient day and NUTIs, indicating that with more nursing hours per day, there were fewer NUTI. These findings document the importance of nursing staff in minimizing hospital-acquired urinary tract infection.

Biopsychological markers of distress in informal caregivers.

Background: Thirty caregiving wives participated in a study of caregiving distress and negative mood (depressive symptoms) by making diary entries on stressful caregiving situations and collecting saliva samples 4 times a day. At the end of the 7-day study period, caregivers' salivary cortisol production was compared with their diary entries and correlated with pencil and paper self-report scores of caregiver distress and depressive symptoms.

Findings: Despite the inability to control a number of factors thought to confound cortisol production (exercise, smoking, alcohol ingestion, and prescription medications), there was a statistically significant difference between No Caregiving and Caregiving cortisol, F(1,739) = 7.

Telehealth for elders and their caregivers in rural communities.

The use of technological strategies in providing care for patients and their families at distant locations has been available since the 1950s. Today's telehealth approaches are proposed to offer considerable promise for enhanced service delivery in rural and other underserved communities. Technology-based delivery methods, such as videophone skill training, and one- and two-way interactive computer networks, are envisioned as contributors for improving rural residents' access to services, individualizing rural health care, increasing rural health practitioners' continuing education opportunities, and improving quality and cost-efficiency of care.

Maximizing retention in community-based clinical trials.

Purpose: To identify and discuss retention strategies and their effectiveness in community-based clinical trials in the last decade.

Methods: Online and hand searches for reports for the period 1990-1999. A total of 87 reports on 64 different trials were found; 21 of these published reports included a description of both retention strategies and outcomes.