Caregiver Competence Research Articles

Preschool teachers and caregivers’ lack of repositioning in response to changed responsibilities in policy documents

Preschool teachers and caregivers have a close working relationship as part of a working team to benefit the children in Swedish preschools. In 2011, a new educational reform was introduced according to which preschools became a school form in their own right within the overall educational system in Sweden. The objective of the policy was to strengthen the profession of preschool teachers by affording them clearer responsibility over the quality of educational practices and curriculum work. It also entailed a division of labour between the preschool teachers and caregivers in the working team. The current study explored how Swedish preschool teachers and caregivers positioned themselves in response to these changes in responsibility. In this qualitative study, data were collected from 17 preschool teachers and caregivers via an open-ended questionnaire. Preschool teachers and caregivers viewed themselves as having equal responsibility in the working team. Specifically, preschool teachers upgraded the competence and position of caregivers while downgrading their own professional competence and position. Caregivers downgraded the profession and position of preschool teachers and upgraded their own competence and position to be equal to that of preschool teachers.

Assessing the impact of a virtual support group on adoptive parent stress and competence: Results from an urban/rural pilot study

AbstractDespite the use of support groups among adoptive parents, few empirical works have assessed outcomes associated with participation in these groups, particularly those delivered via virtual platforms. The purpose of this study was to assess the impact of participation in a virtual, pilot‐phase 10‐week adoptive parent support group, on adoptive parent stress and parental competence. The pilot included support groups at two sites in one south‐eastern state, one urban and the other rural. Data were collected via a retrospective pre‐/post‐design and utilized the Parental Stress Scale and Parental Sense of Competency measures to assess variables of interest. Analyses indicate significant increases in adoptive parent competency and significant decreases in parental stress within support groups at the urban site. No such significant differences were detected for participants in the rural group. Overall, findings indicate that support groups can be beneficial in addressing challenges associated with caregiver stress and competency among adoptive parents. As well, data suggest the need to be attentive to support group structure and duration, among other factors. After a brief review of pertinent background information, this paper will outline findings from this study and discuss salient implications derived from this effort.

Minor Head Injuries in Children

Traumatic head injury continues to be a major problem facing the pediatric specialists despite efforts to reduce its incidence. Aims of our study were assessment of the incidence of hospital admissions of children with minor head injuries, their treatment and outcome. In this prospective study we included 101 patient with head injury. We assessed the hospital admission criteria of children with minor head injuries, their length of stay, symptoms and neurological status, in-hospital imaging and consultations to other medical specialities, together with the outcome of patients on their discharge from the hospital. Of 101 patient 54 (53.46%) were male and 47 (46.53%) female. Average age was 3 years with age range from 5/52 to 12 years. Majority of patients (46.53%) were less than 1 year old. Fall was the most common mechanism of injury (92.07% of all patients). Injuries were witnessed in 51 case (50.49%), unwitnessed in 19 cases (18.81%) and unknown in 31 cases (30.69%). 95 patients did not have associated extracranial injuries, while 5 patients had associated lacerations and one had associated extracranial fracture. Length of stay was from 1 day in 80.19% of all cases to more than 2 days in 6.93%. GCS was recorded on admission and discharge and majority of patients were discharged with GCS of 15. 93% of admissions had no neurological deficit. 79% had 1 or more symptoms including vomiting, sleepiness, LOC and headaches. Over half of patients (55%) had no imaging done. 45 patients (45%) had skull x-ray. CT was performed in 7 (15%) patients and 7 fractures were found on x-ray and CT. 3 patients were admitted to ICU. All injuries were closed and all received conservative treatment. In less than 1 year old group of patients 95% of them were also seen by medical team and social worker. The outcome was good for all patients. We conclude that majority of patients with minor head injury could be supervised and observed at home by a competent care giver. Admitted patients need radiological evaluation, preferably a CT scan. Language: en

Development of the Experienced Communication in Dementia Questionnaire: A Qualitative Study.

Communication problems with their caregivers are common in people with dementia. Although interventions for improvement of communication are being developed, a tool to measure how participants experience their communication is lacking. The objective of this article is to describe the development of a questionnaire that measures the “experienced communication” of persons with dementia (ECD-P) as well as of their caregivers (ECD-C). Interviews were conducted with five person with dementia—caregiver dyads who had recently received a new communication intervention. Reflexive thematic analysis was performed on the transcripts using ATLAS.ti. Codes were created, categories and themes were identified, and items for the questionnaires were generated. Selection of items and response scales was done in collaboration with the same dyads. The final version was established after pilot testing with seven other dyads and discussion with five experts in the field of dementia care. Analysis of the transcripts resulted in 212 codes and 17 categories within four themes: caregiver competence, social communication, communication difficulties in daily life, and experienced emotions during conversations. The final version of the ECD-P consists of part 1 with 22 items and 4-point Likert scales, and part 2 with two items and 1 to 10 scales. In the final ECD-C (proxy version), part 1 and part 2 are similar to the ECD-P, while a part 3 was added to assess caregivers’ own perspective and emotions (five items). Based on the experiences of people with dementia and their caregivers, we constructed a face-valid questionnaire. This justifies future research to test its clinimetric characteristics.

Psychological Well-Being and Positive Aspects of Caregiving: What’s the Relationship?

Many family caregivers derive meaning and purpose from caring for a loved one. Research on the mechanisms underlying positive aspects of caregiving have explored appraisal, reciprocity, resilience, gratitude, mastery, and appreciation. This study aimed to explore how individual personality factors, using the framework of psychological well-being (i.e., autonomy, positive relationships, purpose, personal growth, self-acceptance, and environmental mastery) proposed by Ryff (1989), may influence positive aspects of caregiving. N = 452 family caregivers completed informed consent, provided demographic information, and completed study measures using an online research platform. Multiple regression equations were calculated to assess which aspects of psychological well-being predicted two positive aspects of caregiving: competence and personal gain. The model explained 22% of the variance in caregiving competence, F(6, 445) = 21.01, p < .001. Autonomy (β = .26, p < .001) and self-acceptance (β = .18, p = .02) contributed most significantly to feelings of competence. The model explained 14% of the variance in personal gain, F(6, 445) = 12.11, p < .001. Self-acceptance (β = .19, p = .02), personal growth (β = .18, p = .01) and autonomy (β = .13; p = .03) contributed most significantly feelings of personal gain. Psychological well-being, specifically feelings of autonomy and self-acceptance, are modest predictors of feelings of competence and gain, and psychological well-being appears to have an effect on positive aspects of caregiving. Interventions for family caregivers should consider ways of building autonomy, self-acceptance, and growth to increase feelings of competence and gain.

Emory Roybal Center for Dementia Caregiving Mastery: Diverse Responses to Letter of Intent Call

This new NIA-supported Roybal Center seeks to support Stage 1 pilot clinical trials of programs aimed at promoting caregiving competence and confidence in the great heterogeneity of dementia caregiving contexts. During our first cycle, we received 26 letters of intent (LOI) for full applications. Responses reaffirmed the Center’s premise that dementia caregiving is remarkably varied in nature. While most proposed programs focused on generic caregiving, a number addressed caregiving issues facing specific ethnic/racial groups (African American; Korean American; Native Alaskan/American Indian; Latino), and several focused on specific dementing conditions (MCI, Lewy Body Dementia,TBI-based dementia). Most described programs centered on knowledge development and daily management skill issues (e.g., management of behaviors); others specified development of physical care skills. Decision-making and communication constituted the second most common topic. Over 40% proposed adaptation of existing programs; more than 25% proposed apps or technology interventions. Investigators represented a wide range of disciplines: 45% each from Health sciences (nursing, medicine, and social work) and Social/Behavioral sciences (principally psychology) and the rest from engineering and communications. LOIs varied most in their readiness to complete a clinical trial within a year. About 40% were in very preliminary stages; 25% were clearly poised for a Stage 1 trial; 15% did not sufficiently address the Center’s aims. Key criteria for invitations to submit full applications (n=4) included: specificity of context; clinical trial readiness; reasonableness of proposed adaptation. These criteria should guide future LOIs addressing the diversity of important new research and intervention perspectives on the multifaceted work of caregiving.

Dementia Caregiver Satisfaction and Utilization of a Telehealth App: Results From the FamTechCare Trial

Technology can enhance support for families caring for persons with dementia but must be acceptable to be adopted. In the FamTechCare trial, caregivers used an app to videorecord care encounters that were reviewed by an expert panel who provided tailored feedback. The intervention reduced caregiver depression and improved caregiver competence. This mixed methods study reports caregiver satisfaction and utilization of the intervention and evaluation of the intervention by the expert panel. A convergent parallel mixed methods design was used to evaluate the satisfaction, usability, and feasibility of the intervention. Caregiver-person with dementia dyads were randomized to the FamTechCare video support or telephone attention control support groups. Caregivers completed a satisfaction survey at the completion of the 3-month trial. The number and duration of videos submitted and calls received by caregivers were used to evaluate utilization. Relationships between participant characteristics and satisfaction and utilization were evaluated. Feasibility and future directions for the intervention were assessed through interviews with the expert panel. The majority of caregivers in both groups reported benefits from participation. More FamTechCare caregivers found the interventionist support to be helpful (p=.001) and effective (p=.020) compared to attention control caregivers. FamTechCare caregivers of persons with more severe dementia were more likely to report that video recording intruded on their privacy (p=.050). Age, gender, education, dyad relationship, rural status, and type and severity of dementia were not associated with ratings of acceptability, ease of use, or intervention utilization. The expert panel rated FamTechCare as useful and identified adaptations to enhance feasibility.

Home or hospital as the place of end-of-life care and death: A grounded theory study of parents’ decision-making

Background: While several studies have examined ‘what’ families want with regard to the place of a child’s end-of-life care and death, few have explored ‘how’ parents reach a decision. Aims: (1) to develop a model explaining how parents of a child with a life-threatening illness in Greece decide about the place of end-of-life care and death; (2) to identify the factors affecting decision-making; (3) to consider the implications for clinical practice. Design: Grounded theory study of bereaved parents using semi-structured open-ended interviews following Strauss and Corbin’s principles of data collection and analysis. Setting/participants: Semi-structured interviews with 36 bereaved parents of 22 children who died at home (n = 9) or in a paediatric hospital (n = 13) in Athens, Greece. Results: (1) Decisions regarding place of care and death were reached in one of four ways: consensus, accommodation, imposition of professional decisions on parents or imposition of parents’ decisions without including professionals. (2) Six factors were identified as affecting decisions: awareness of dying, perceived parental caregiving competence, perceived professional competence, parents’ view of symptom management, timing of decision-making, and being a ‘good parent’. (3) Decisions were clear-cut or shifting. Few parents did not engage in decisions. Conclusion: Parents’ decisions about place of end-of-life care and death are affected by personal, interpersonal, timing and disease-related factors. Parents are best supported in decision-making when information is presented clearly and honestly with recognition of what acting as ‘good parents’ means to them, and opportunities to enhance their caregiving competence to care for their child at home, if they choose so.

Relationship Between Quality of Life of Children With Cancer and Caregiving Competence of Main Family Caregivers.

The purpose of this study was to describe the caregiver's proxy-report of the quality of life (QoL) of children with cancer and the main family caregiver's competence, and to examine the role of said competence and other care-related variables in their proxy-reported QoL of children with cancer. This was a cross sectional, correlation design study conducted with 97 main family caregivers of children between the ages of 8 and 12 years with cancer residing in Colombia. The following variables were collected: main family caregiver and child sociodemographic characteristics (Survey for Dyad Care; GCPC-UN-D), The Pediatric Quality of Life Inventory 4.0 Cancer Module, and the Competence Instrument (caregiver version). The mean of the children's QoL was 102.0 points, and the caregivers' competence score was 211.24. Caregiver's competence (t = 5.814, p < .01), marital status (t = 1.925, p < .05), time as a caregiver (t = 2.087, p < .05), number of hours spent caring for the child (t = 2.621, p < .05), and caregiver's previous caring experiences (t = 2.068, p < .05) were found to influence caregiver's proxy-report of the QoL of children with cancer. High competence in main family caregivers positively influence caregiver's proxy-report of the QoL of children with cancer. Study results also suggest that nurses should consider the caregivers' sociodemographic characteristics such as marital status, time as a caregiver, number of hours spent caring for the child, and caregiver's previous experiences because those aspects influence main family caregivers' proxy-report about their children's QoL.

Disability Severity and Home-Based Care Quality in Older Adults: The Mediating Effects of Social Support and Caregiver Competence.

ABSTRACTBackgroundThe lack of adequate medical care, healthcare, and older adult care in remote, low-income, rural Kazakh areas of China is a particular concern that should be prioritized for improvement.PurposeThis study was designed to explore the relationship between the variables of disability severity, social support, and caregiver competence and the quality of home-based care in a population of Kazakh older adults with disabilities and to analyze the path between severity of disability and quality of home-based care in this population.MethodsA cross-sectional survey was conducted on 335 Kazakh older adults with disabilities living in Xinjiang, China, and their primary informal caregivers. Disability severity was assessed using the Activities of Daily Living Scale, caregiver competence was assessed using the Family Caregiver Task Inventory, social support was assessed using the Social Support Rating Scale, and home-based care quality was assessed using the Family Caregiving Consequences Inventory Scale. Path analysis was used to check the effects of other variables on the quality of home-based care.ResultsSignificant correlations were found among disability severity, caregiver competence, social support, and home-based care quality. Disability severity was shown to have a 29.28% direct effect on home-based care quality and a 70.72% indirect effect through social support and caregiver competence.ConclusionsThe results of this study confirm that better social support and caregiver competence improves the quality of home-based care available to older adults with disabilities. Policymakers should give priority to improving the quality of care provided to community-dwelling older adults with severe disabilities. Furthermore, health management departments should provide informal caregiver training that teaches care and rehabilitation knowledge and skills to improve the competencies of caregivers.

Intermediate outcomes of a randomized trial of Tele‐Savvy: An online psychoeducation program

AbstractBackgroundThis presentation provides an intermediate report on the outcomes of the first twenty cohorts of family caregivers (N=220) engaged in a NIA‐supported randomized, three‐arm trial of Tele‐Savvy, a fully online version of the Savvy Caregiver, an evidence‐based in‐person psychoeducation program. Tele‐Savvy is specifically aimed at enhancing caregivers’ capacity to manage the day‐to‐day challenges of caregiving by promoting caregiving mastery; the intended outcome is the reduction of caregiving distress. Tele‐Savvy engages groups of 5‐8 caregivers in 7 weekly synchronous online groups led by a trained facilitator; in between, caregivers are provided with 36 daily video lessons they can view whenever and as often as they wish. Caregivers were recruited in cohorts of 15 from 34 states and 2 Canadian provinces and randomly assigned (in a 2:2:1 ratio) to immediate participation in Tele‐Savvy, an attention control condition (Healthy Living), or usual care.MethodData reported here were gathered on key outcomes at baseline and then 3 and 6 months. Multilevel mixed models were used to test for group, time, and group‐by‐time effects for each of the outcomes.ResultWe found a significant group‐by‐time effect on CES‐D‐assessed caregiver depression (p&lt;.001) with the active group showing significant decreases over time (p&lt;.001). Of note, 35% of the active group reported clinically significant depression at baseline; this reduced to 22% by six months. In contrast, 25.5% those in the waitlist group scored as clinically depressed, a figure that increased to 33% by six months. We found a significant group‐by‐time effect on caregiver perceived strain (p&lt;.001) with the active group demonstrating significant reductions over time (p&lt;.001) and the waitlist control group demonstrating significant increases (p=.010). Likewise, there was a significant group‐by‐time effect (p=.001) on caregivers’ reactions to care recipient behaviors (RMBPC) with significant reductions over time among the active caregivers (p=.001). Caregiver competence demonstrated a significant group‐by‐time effect (p‐.009) with the active group demonstrating significant increases over time (p&lt;.001). Findings regarding caregivers’ management of the situation were comparable: a significant group‐by‐time effect (p=.003) with the active group demonstrating significant increases over time (p&lt;.001).ConclusionAt this point, Tele‐Savvy appears to be achieving its aims of enhancing mastery and decreasing distress.

Cost-effectiveness of a telehealth intervention for in-home dementia care support: Findings from the FamTechCare clinical trial.

Determining the cost-effectiveness of technological interventions is a crucial aspect in assuring these interventions can be adopted. The FamTechCare intervention is an innovative telehealth support that links family caregivers of persons living with dementia to tailored feedback from dementia care experts based on caregiver-initiated video recordings of challenging care situations. The FamTechCare intervention has demonstrated significant reductions in caregiver depression and increases in caregiver competence when compared to standard telephone support. The purpose of this article is to report on the cost-effectiveness of the FamTechCare telehealth intervention. Process-based costing and a cost-effectiveness analysis using the incremental cost-effectiveness ratio (ICER) was completed with 68 caregiver and person living dementia with dyads. The cost of the 12-week FamTechCare telehealth intervention was found to be greater ($48.43 per dyad per week) due to the telehealth equipment, recording application, and expert panel time compared with the telephone support intervention ($6.96 per dyad per week). The ICER was $18.51 for caregiver depression and $36.31 for caregiver competence indicating that it cost no more than $36.38 per dyad per week over 12 weeks to achieve significant improvement in depression and competence in the FamTechCare caregivers compared to the telephone support caregivers. The FamTechCare intervention appears to be cost-effective when compared to the telephone support intervention and remains near the willingness-to-pay threshold for caregivers providing in-home dementia care support.

Predicting Caregiver Burden in Informal Caregivers for the Elderly in Ecuador

Informal caregivers are the main providers of care for the elderly. The aim of this study is to examine the predictive value of different variables regarding caregivers and their elderly patients with respect to the caregiver’s burden. A convenience sample of 688 informal caregivers and 688 elderly people from Ecuador was surveyed. Only households with one caregiver and one elderly person were considered for the study. For informal caregivers, the following standardized measures were obtained: burden (Zarit Burden Interview), neuroticism (Eysenck Personality Questionnaire Revised-Abbreviated, EPQR-A), caregiver’s general health (GHQ-12), and social support (modified Duke-UNC Functional Social Support Questionnaire, FSSQ11). For the elderly, we employed standardized measures of cognitive function (short portable mental status questionnaire, SPMSQ), Pfeiffer’s test, and functional dependency (Barthel scale/Index, BI). Females were over-represented in caregiving and reported significantly higher burden levels than those of males. In both male and female caregivers, the burden was best predicted by the time of caring, neuroticism, and elderly cognitive impairment. However, some predictors of burden were weighted differently in males and females. The functional independence of the elderly was a significant predictor of burden for male caregivers but not females, while caregiver competence was a significant predictor for females but not males. These variables accounted for more than 88% of the variability in informal caregivers.

NICU Fathers: Improving the Quality of Paternal Support in the NICU.

Parental support in the neonatal intensive care unit (NICU) is critical; yet, the nursing staff may struggle to provide optimal support to NICU fathers. Generally, fathers are not viewed as equally competent caregivers when compared with mothers, and fathers often impart these beliefs on themselves. Increasing the nursing staff's knowledge and understanding of paternal support can change attitudes and foster positive behavior changes, enhancing the perception of support received by NICU fathers. To implement a needs assessment and educational intervention for the nursing staff designed to increase the perception of nursing support received by NICU fathers. The Nurse Parents Support Tool (NPST) was administered to the clinical nursing staff and fathers in a pre/posttest design comparing support given by nurses with the fathers' perception of received support. Data from the preintervention assessment was used to design an educational intervention on improving fathers' support. Following the intervention, a postintervention NPST was administered to fathers to determine whether there was an improvement in support perception. Improvement in the NICU fathers' perception of nursing staff support was noted between father groups. In addition, the NPST can be used to assess paternal support needs and develop staff education. Support provided to NICU fathers can enhance the father's perception of himself as an equal and competent caregiver, leading to improved father-infant bonding as the child ages. Educational interventions targeting father support should be a routine part of nursing staff training. Future research should examine the long-term effects of early paternal support on psychosocial, cognitive, and developmental outcomes of NICU infants.

"I Have Everything to Win and Nothing to Lose": Patient Experiences of Mobilization Out of Bed Immediately After Abdominal Surgery.

ObjectiveEarly mobilization is advocated for patients going through abdominal surgery; however, little is known about the patient experience of being mobilized immediately after surgery. The purpose of this study was to explore patient experiences of mobilization immediately after elective abdominal cancer surgery.MethodsThis interview study used qualitative content analysis. With the use of purposeful sampling, a total of 23 participants who had been mobilized immediately after abdominal surgery were recruited at a university hospital in Stockholm, Sweden. Individual face-to-face interviews were conducted within 1 to 4 days after surgery and took place at the surgical ward where the participants were treated. A semi-structured guide was used. All interviews were audio recorded and transcribed verbatim.ResultsThe content analysis revealed 3 categories that emerged into 1 overarching theme: “to do whatever it takes to get home earlier.” The participants experienced that mobilization out of bed had an impact on their physical and mental well-being. Motivation and the experiences of themselves and others were factors that affected patient attitudes toward early mobilization. Preparation and competent caregivers were emphasized as important factors that enabled the patient to feel safe and confident during mobilization.ConclusionsPatients experienced mobilization as an important part of the care that had an impact on recovery and well-being, physically as well as mentally, both immediately and over time.ImpactAs this is the first study to our knowledge to investigate patient experiences of mobilization immediately after abdominal surgery, this information can be used to support the development of early mobilization protocols in hospital settings.

Caregiver experiences of paediatric inpatient cardiac services: A qualitative systematic review.

Advances in paediatric care have contributed to an increasing survival of children with complex heart disease. Yet, life-saving management demands prolonged inpatient admissions, which contribute to emotional and psychological distress for parents and other caregivers in a role of main custody. The purpose of this study was to identify, appraise and synthesise qualitative studies exploring caregivers' experiences of paediatric inpatient cardiac services, generating an understanding of their needs in hospital and informing priorities for change in healthcare delivery. Searches were conducted in Medline, Allied and Complimentary Medicine Database, Cumulative Index of Nursing and Allied Health Literature, EMCARE, Scopus, PsychINFO, Proquest, OpenGrey and ETHOs from 2008-2019, reflecting recent advances in cardiac healthcare. Articles were selected using predetermined eligibility criteria dictating qualitative inquiry into caregiver perspectives whilst their child received hospital-based interventions for heart disease. All eligible studies underwent quality appraisal. Framework synthesis was used to analyse and summarise findings. Twenty-seven studies involving 689 caregivers from 11 countries were included. Three overarching themes were identified: 'emotional capacity to care', 'practicalities of caring', and 'the bigger picture of caring'. Through analysis and summary of qualitative primary research, this review captures the emotional challenges that caregivers face and practicalities of undertaking a caregiver role, whilst looking after their child with heart disease in hospital. The results widen the context of the caregiver role, encompassing the whole family unit beyond the hospital environment. This review exposes the impact of these challenges on caregiver competence, wellbeing and attachment to their unwell child, informing priorities for development of family-centred paediatric inpatient cardiac services.

Satisfaction, utilization, and feasibility of a telehealth intervention for in-home dementia care support: A mixed methods study.

Technology can enhance support for families caring for persons living with dementia but must be acceptable to be adopted. The FamTechCare clinical trial engaged caregivers in video recording care encounters that were reviewed by an expert panel who provided tailored feedback. The intervention reduced caregiver depression and improved caregiver competence. This mixed methods study reports on caregiver satisfaction and utilization of the intervention and expert panel evaluation of the intervention. A convergent parallel mixed methods design was used to evaluate the satisfaction, usability, and feasibility of the FamTechCare intervention. In the multisite randomized controlled trial, caregiver-person living with dementia dyads were randomized to the FamTechCare video support or attention control telephone support groups. Caregivers completed a satisfaction survey at the completion of the 3-month trial. Utilization was evaluated using the number and duration of videos submitted and calls received by caregivers. Relationships between participant characteristics and their satisfaction and utilization were evaluated. Feasibility of the intervention was assessed through content analysis of interviews with the expert panel. The majority of caregivers in both groups reported benefits from participation. More FamTechCare caregivers found the interventionist support to be helpful (p = 0.001) and effective (p = 0.020) compared to attention control caregivers. FamTechCare caregivers of persons with more severe dementia were more likely to report that video recording intruded on their privacy (p = 0.050). Caregiver age, gender, education, dyad relationship, rural status, and type and severity of dementia were not associated with ratings of acceptability, ease of use, or intervention utilization. The expert panel described the FamTechCare intervention as useful and identified adaptations to enhance feasibility. Regardless of age, gender, and relationship, caregivers found the intervention acceptable and easy to use and rated the expert feedback as effective in addressing care challenges. Further adaptation may be needed for FamTechCare to be readily implemented.

Effect of a Planned Health Teaching on Improving Knowledge and Competence of Home Care Practice of Post Stroke Patient Among Caregivers' Achievement

Background: Stroke is one of the major healthcare challenges, being one of the leading causes of death, disability, and dependency in the activity of daily living worldwide Homecare of stroke patients is having a great role in the patient recovery. Patient family caregivers and relatives can play an important role in the care of patients. But how to continue proper care of the patient at home after discharge, they don't know what to do and don't have practice as well. In this view, the researcher believes that it might be a great help for caregivers and the patients to teach theirs about stroke and home care of stroke patients. Objective: The study aims to evaluate the effectiveness of a planned health teaching on the caregiver's knowledge and competence of home care of stroke patients. Therefore, improve the patients' functional ability. Methods: The two group pre and post-test, quasi-experimental design was conducted among 50 caregivers of stroke patients, assigned to 25 caregivers as a control group and 25 caregivers as an experimental group. The study was done in the university hospital at El Fayoum city from 1st March 2019 to 31st August 2019. Four tools were used for data collection after reviewing relevant data as the following; a structured interviewing questionnaire, caregiver's knowledge questionnaire regarding stroke, caregiver's practices regarding bed position, Position Change and Transfer, and Range of Motion Exercises, and patient function ability assessment according to Barthel index. Results: revealed that there was a poor score level of knowledge and competence of home care practices before the intervention. However, there was an improvement of score level in the control and experimental group post-intervention, but the higher score was observed in the experimental group. The mean score level of patient functional ability in the experimental group improved than the control group through follow up. Highly statistical significance was found between control and experimental group post-intervention related to knowledge and practices. A positive significant correlation between caregiver's practices and patients function ability in the experimental group was found. Conclusion: planned health teaching is important after patients discharge to increase the caregiver's knowledge and competence of home care practices of post-stroke patients; resulting in improved patient functional ability.

Employees' experiences of education and knowledge in intellectual disability practice

AbstractBackgroundThe value of support, service, and care in intellectual disability (ID) practice is linked to the competence of the professional caregivers. The quality of work is affected by the level of education of healthcare employees involved.Specific AimsThis study aimed to collect data on how employees perceive their education and training in ID practice and how educational programs prepare them for their working environment.MethodsWe used a quantitative approach to investigate how employees reflect on their knowledge about ID and other disabilities and the sources of such knowledge. A total of 262 employees engaged in ID practice completed an online survey.FindingsThe results indicated that education significantly influenced the participants' knowledge level, and highly specific education (i.e., workplace training) can substitute for work experience in ID practice. The authors conclude that all workplaces should examine their employees' skills regularly from the viewpoint of fulfilling the needs of people with ID.DiscussionBased on the results, it can be concluded that employees in ID practice need specific knowledge through workplace training (i.e., through hands‐on practice at the workplace). Competence development in the form of workplace training is needed to upskill the staff and possibly increases employees' participation at work.

Family Perceptions of Quality of Life for Pediatric Home Ventilator Patients

Home mechanical ventilation is an alternative to institutional management for some children with chronic or degenerative respiratory and neuromuscular disorders. Over the past 20 years, Children’s Hospital of Philadelphia has enhanced its Home Care Home Ventilator Program, designed to transition hospitalized children requiring long-term mechanical ventilation safely home. Program goals include supporting patient safety, medical stability, and caregiver competence while promoting quality of life. This longitudinal quality improvement project examined perceived quality of life for families with children discharged home for the first time on mechanical ventilation. We sought to identify unmet needs related to this transition. A self-report quality-of-life survey adapted from several validated tools was completed by the primary caregiver at 3 specific times over 6 months. Repeated-measures general linear modeling examined changes over time in caregivers’ perceptions of quality of life and confidence in meeting their child’s ongoing healthcare needs. After completing the inpatient portion of the program, followed by 6 months caring for their child at home with support from the hospital’s Home Care Department and Technology Dependence Center, caregivers reported more time to attend to their own needs and family activities, less financial burden, less anxiety, and perceived improvements in their child’s health and quality of life compared with hospitalization. Based on our findings, one program change was implemented: the Home Care social worker now meets with the family prior to discharge.