Caregiver Preparedness Research Articles

The effect of caregiver's and nurse's perception of a patient's discharge readiness on postdischarge medical resource consumption.

The purpose of this study was to validate patient's primary caregiver and their nurse's perception of patient discharge readiness assessment and their association with postdischarge medical consumption. The study employed a descriptive research, prospective longitudinal study design. The study was performed in a ward of a medical centre in Taipei, Taiwan, from June 2017-May 2018. Obtained data were analysed using an independent t test, one-way ANOVA and logistic regression approach. The number of comorbidities and the number of days of hospital stay were positively associated with post discharge emergency room visits. Caregiver readiness for hospital discharge had significant negative correlation with patient's 30-day readmission. Both caregiver and nurse readiness for the hospital discharge scale score were not factors associated with the patients' 30-day emergency room visit. Based on the research findings, to assess the discharge readiness as perceived by caregivers at patients' discharge is recommended. Caregiver and nurse scores on readiness for hospital discharge showed a significant positive correlation. The higher the score of a caregiver's readiness for a patient's hospital discharge, the lower the 30-day readmission rate. Family-centred care enables patients to safely pass though the transition phase from hospital to community and reduces the postrelease consumption of medical resources. The discharge readiness perceived by caregivers should be included in any decision-making.

33 Effectiveness of Caregiver-oriented Transitional Care Program (CTCP) in Promoting Preparedness of Caregivers for Home Care of Burn Patients

Abstract Introduction Unpreparedness of caregivers of burn patients can result to several complications at post-discharge period (Zwicker, 2010; AHRQ, 2012). Some burn centers in resource-scarce countries had documented several burn morbidity and mortality that occurred post hospital discharge. Psychological conditions, contractures, infection and even death are just some of the complications. One of the current trends in burns involves sending patients home with a burn dressing and following them up as outpatients for wound inspection. This could significantly reduce cost of hospitalization with shortened hospital stay and allows burn units to accommodate the overflow of acute and complex cases for admission. Although there are advantages in early discharge, this approach requires a change in the health teaching method and contents since hospital-to-home transition is expedited. Considering this dilemma, the investigator developed the CTCP to address the gap in transitional care of burns. This study aimed to compare the preparedness of caregivers before and after CTCP; and compare caregivers’ handwashing competency, wound dressing competency and medication administration hassle before and after CTCP. Methods One-group pre-and-posttest quasi-experimental design was used to study thirty adult caregivers of burn patients that were recruited via convenience sampling in a burn center between November 2017 to March 2018. CTCP was conducted in three sessions with the aid of videos and written instructional materials. Caregivers were evaluated in terms of preparedness (primary outcome) and handwashing competency, wound dressing competency and medication administration hassle (secondary outcomes). All measurement instruments were content valid and reliable. Results At alpha 0.05, data analysis revealed statistically significant results supporting the use of CTCP. Preparedness (p< 0.001), handwashing competency (p< 0.001), wound dressing competency (p< 0.001) and medication administration hassle (p< 0.001) improved after receiving the structured teaching intervention. Conclusions The study supported the relevance of the interventions to prepare caregivers for home care of burn patients to help prevent potential complications after hospital discharge. This is therefore recommended to be adapted by burn units that recognize primary caregivers as extended team members. Applicability of Research to Practice Since there is a limited evidence in nursing discharge education programs specific to burns, the results generated from this study can help practitioners effectively prepare caregivers for home care of burn patients as educational intervention is supported with strategies that increase learning retention.

The effectiveness of a nurse-led intervention to support family caregivers in end-of-life care: Study protocol for a cluster randomized controlled trial.

AimTo evaluate the feasibility of a structured nurse‐led supportive intervention and its effects on family caregivers in end‐of‐life care at home.BackgroundFamily caregivers are crucial in end‐of‐life care. They may experience burden due to the responsibilities associated with caregiving. Some family caregivers feel insufficiently prepared for their caregiver role. Nurses have a unique position to provide supportive interventions at home to reduce caregivers’ burden and improve preparedness. However, few nurse‐led interventions are available to support family caregivers in end‐of‐life care at home.DesignWe will perform a cluster randomized controlled trial. The clusters consist of twelve home care services, randomly assigned to the intervention group or the control group.MethodsThe study population consists of family caregivers of patients in the last phase of life. In the intervention group, nurses will systematically assess the supportive needs of family caregivers, using an assessment tool and the method of clinical reasoning. Family members of the control group receive care as usual. Primary outcome is burden measured by the Self‐Rated Burden Scale. Secondary outcomes are preparedness for caregiving, caregiving reactions and acute (hospital) admissions of the patient. In addition, the feasibility of the intervention will be evaluated. The study was funded in October 2016 and was ethically approved in April 2019.ImpactFindings from this study will contribute to the scientific and practical knowledge of nursing interventions to support family caregivers in end‐of‐life care.Trial registrationThe Netherlands Trial Register (NL7702).

The Influence of Caregiver Preparedness on Caregiver Contributions to Self-care in Heart Failure and the Mediating Role of Caregiver Confidence.

Caregiver contributions (CC) to heart failure (HF) self-care maintenance (ie, CC to maintaining HF stability) and management (ie, CC to dealing with HF signs and symptoms) improve patient outcomes, but it is unknown whether caregiver preparedness influences CC to self-care and whether caregiver confidence mediates this process. We evaluated the influence of caregiver preparedness on CC to HF self-care maintenance and management and the mediating role of caregiver confidence. This is a secondary analysis of the MOTIVATE-HF study. Patients were 18 years or older, with a diagnosis of HF in New York Heart Association classes II to IV, who had insufficient self-care and did not have severe cognitive impairment. Patients' informal caregivers were those people inside or outside the family who gave most of the informal care to the patients. We used the Caregiver Preparedness Scale and the Caregiver Contribution to Self-Care of HF Index. We tested a path analysis model and the indirect effects. Caregivers (n = 323) were 55 (SD, 15) years old on average and predominantly female (77%). The path analysis showed that higher scores in caregiver preparedness were associated with higher scores in caregiver confidence. In turn, higher caregiver confidence was associated with higher CC to self-care maintenance and management. Caregiver confidence mediated the association between caregiver preparedness and CC to self-care maintenance and management. Caregiver confidence may play a role in CC to self-care. Interventions to improve CC to HF self-care should not only be focused on improving caregiver preparedness but also should consider the role of caregiver confidence.

Abstract WP463: Moderator Role of Preparedness on the Association Between Depression and Quality of Life in Stroke Survivor-Caregiver Dyads

Background: Although several studies have clearly shown that depressive symptoms in stroke survivors and caregivers decreases their quality of life (QOL), previous research has not yet analyzed the role of potential moderators in the relationship between the above two variables. Aims: To examine the moderating effect of caregiver preparedness between depressive symptoms and QOL in stroke survivor and caregiver dyads. Methods: Longitudinal design with 222 stroke survivor-caregiver dyads enrolled at survivor discharge from rehabilitation hospitals. Data collection was performed over 12 months. We measured survivor and caregiver QOL dimensions (physical, psychological, social and environmental), depression and preparedness. Hierarchical Linear Modeling was used to test four longitudinal dyadic moderation models (one for each QOL domain). Results: Survivors (50% males) and caregivers (65% females) were 70.8 (SD=11.9) and 52.5 (SD=13.1) years old, respectively. Controlling for baseline covariates, caregiver preparedness significantly moderated the association between survivor depressive symptoms and survivor psychological (B = 0.56, p < .01) and environmental (B = 0.58, p < .01) QOL at baseline and social QOL over time (B = 0.24, p < .05). In each case, higher levels of caregiver preparedness were protective and buffered the influence of survivor depressive symptoms on survivor QOL. Similarly, caregiver preparedness significantly moderated the association between caregiver depressive symptoms and caregiver physical (B = 0.25, p < .01) and environmental (B = 0.18, p < .05) QOL over time. Conclusions: Caregiver preparedness is a positive variable for both members of the dyad and the paper highlights the importance of implementing tailored intervention which could improve caregivers’ preparedness already during the rehabilitation period.

Transitional care for older people from hospital to home: a best practice implementation project.

The objective of this implementation project was to promote evidence-based practice of transitional care for older people from hospital to home. The transition following hospitalization is a critical period of health risk for older people and their family caregivers. Older people need to learn how to take care of themselves at home safely, and caregivers play an important role in caring for them both in hospital and at home. A clinical audit was undertaken using evidence-based criteria regarding transitional care. Eight audit criteria that represented best-practice recommendations of transitional care for older people from hospital to home were used. A baseline audit was conducted, followed by the implementation of transitional care strategies, and the project was finalized with a follow-up audit to determine the change in practice. Improvements in clinical practice were identified in relation to healthcare professional knowledge regarding transitional care, patient care needs during the transition and a multifaceted approach during the transition phase. The project demonstrated positive changes in the transitional care for older people from hospital to home. A multifaceted approach, including patient-centered discharge instruction, telephone follow-up and family caregiver preparedness, is required for older adults to be successfully discharged from hospital to home.

Interventions supporting caregiver readiness when caring for patients with dementia following discharge home: A mixed-methods systematic review.

To explore programs and information provided to caregivers of inpatients with dementia to assist with readiness to provide care following discharge. A mixed-methods systematic review with meta-analysis was conducted. Search terms included dementia, inpatient, caregiver, anxiety, discharge and counselling. The search yielded 1938 studies (six databases), 13 met the inclusion criteria. Meta-analysis showed no statistically significant changes in anxiety, depression, burden or quality of life 3months postintervention. Three emergent qualitative themes for staff consideration are as follows: understanding personal characteristics of both patient and caregiver; presenting an inclusive organisational culture; and providing appropriate information at all stages of admission. A Model of Caregiver Readiness was created from the qualitative results. The programs did not significantly decrease the outcomes measured. However, caregivers identified that inclusion at all stages during hospital admission was a vital factor to reduce stress and increase caregiver readiness.

Communication between Advanced Cancer Patients and Their Family Caregivers: Relationship with Caregiver Burden and Preparedness for Caregiving

ABSTRACT Cancer impacts spouse caregivers, especially when couples engage in dyadic coping around the cancer. Communication is a key factor in this process. Our goals were to describe cancer-related communication between advanced cancer patients and their spouse caregivers, and to describe how dyadic communication patterns are related to caregivers’ reported burden and preparedness for caregiving. Caregivers completed measures of caregiver burden and preparedness for caregiving. Then, the patient and caregiver were asked to interact with each other in two structured discussions: a neutral discussion and a problem discussion focused on cancer. Discussions were coded using the Rapid Marital Interaction Coding System (RMICS2). Caregivers reported moderate levels of preparation and burden. Greater caregiver hostility communication predicted higher levels of caregiver burden, whereas greater caregiver dysphoric affect communication predicted lower levels of caregiver burden. Whereas positivity was more common than hostility in couples’ communication, patient hostility was a significant predictor of caregiver preparedness. Patient neutral constructive problem discussion was also associated with increased caregiver preparedness. Caregiver outcomes are an understudied component to dyadic cancer research. Our paper describes observational data on cancer-related communication between caregivers and advanced cancer patients and communication’s influence on caregiver outcomes. This work provides the foundation for future evidence-based communication interventions that may influence both patient and caregiver outcomes.

Caregiver Issues and Concerns Following TBI: A Review of the Literature and Future Directions

Survival following traumatic brain injury (TBI) has increased following advances in medical care. However, TBI survivors often experience significant deficits in cognitive function, psychological disturbance, and residual physical deficits. The caregivers for these survivors, who are often family members, may have limited capacity to provide the services and care that are required. Limitations in capacity may be attributable to poor preparation, increased burden, lack of appropriate resources, and lack of required support. Likewise, there are resultant consequences for the caregiver and the survivor. The purpose of this paper is to review issues associated with caregiver capacity including preparation, burden, burnout, and consequences. In the latter portion of the paper, assessment of caregiver readiness and understanding and intervention is described (as well as current limitations). The final portions of the paper describe future directions, the call for increased research, and medicolegal implications.

Preparedness of Caregivers of Cancer Patients to Provide Care

Preparedness of Caregivers of Cancer Patients to Provide Care

“A Crazy Roller Coaster at the End”: A Qualitative Study of Death Preparedness With Caregivers of Persons With Dementia

IntroductionCaregivers of persons with dementia experience challenges that can make preparing for end-of-life particularly difficult. Feeling prepared for death is associated with caregiver well-being in bereavement and is promoted by strategies supporting a palliative approach. Further conceptualization of caregiver preparedness for death of persons with dementia is needed to guide the practice of healthcare providers and to inform development of a preparedness questionnaire.ObjectivesWe aimed to: 1) explore the end-of-life experiences of caregivers of persons with dementia to understand factors perceived as influencing preparedness; and 2) identify the core concepts (i.e., components), barriers and facilitators of preparedness for death.MethodsThis study used an interpretive descriptive design. Semi-structured interviews were conducted with sixteen bereaved caregivers of persons with dementia, recruited from long-term care homes in Ontario. Data was analyzed through reflexive thematic analysis.FindingsFour themes were interpreted including: ‘A crazy rollercoaster at the end’ which described the journey of caregivers at end-of-life. The journey provided context for the development of core concepts (i.e., components) of preparedness represented by three themes: ‘A sense of control, ‘Doing right’ and ‘Coming to terms’.ConclusionThe study findings serve to expand the conceptualization of preparedness and can guide improvements to practice in long-term care. Core concepts, facilitators and influential factors of preparedness will provide the conceptual basis and content to develop the Caring Ahead: Preparing for End-of-Life with Dementia questionnaire.

DEVELOPING A CONCEPTUAL MODEL OF FAMILY PREPAREDNESS FOR FUTURE DEMENTIA CAREGIVING IN CHINESE FAMILIES

Dementia is a growing health challenge that demands better public preparedness. Persons with dementia often lack the capacity to make and execute plans such that family involvement in care preparation becomes necessary. It is commonly observed in Chinese societies that there are more than one family members involved in the taking care of the person with dementia. The current qualitative study aims to understand preparedness for dementia caregiving of a family as unit in a Chinese society. In-depth interviews with 10 family units of dementia caregivers were conducted. Participants (4 spousal caregivers; 44 to 80 years old; mean years of caregiving: 3.3) reflected on how prepared their families were before the caregiving began. Thematic analysis was applied to examine the family preparedness and the family dynamics throughout the caregiving journey. As opposed to a crisis-driven involvement, involvement of more family members before crisis was helpful for reducing the damage brought to the family. Furthermore, families that could align their expectation and understanding of the situation, share knowledge and resources, negotiate the allocation of caregiving duties, and provide emotional support among family members were more likely to provide proper care with minimal sacrifice in family wellbeing. Chinese families often worked as a caregiving team, yet, with uneven distribution of caregiving duties and a lack of proper communication to sustain their caregiving role healthily. Timing and quality of family involvement were more influential factors than family resources to successful adaptation to caregiving.

FAMILY CAREGIVER READINESS: RACIAL DIFFERENCES AND RELIABILITY OF THE CAREGIVER READINESS SCALE

The success of any intervention for caregivers of persons with dementia is dependent on the caregiver’s readiness to enact the strategies. This presentation explores the reliability of the new 17-item Caregiver Readiness Scale (CRS) and also to examine the differences by race in readiness. Participants were caregivers in the Dementia Behavior Study who completed the CRS at baseline (n=129). Caregivers were on average 65.8 years old (sd = 12.2, range 28-88), the majority reported their race as non-Hispanic white (64.3%, n=83) and 33.4% (n=43) reported their race as African American or other. The average CRS score was 57.63 (sd=5.72, 40-68) (α=0.73). The only significant interaction with race was negative communication (p=0.026) with negative communication scores having little effect on readiness in whites, but in non-white caregivers, there was an inverse relationship. Knowing the caregiver’s level of readiness and communication style may help improve the acceptability and success of an intervention.

INTEREST GROUP SESSION—BEHAVIORAL INTERVENTIONS FOR OLDER ADULTS: ADDRESSING CLINICAL SYMPTOMS OF DEMENTIA: PRELIMINARY RESULTS FROM DEMENTIA BEHAVIOR TRIAL

Currently, just under six million people living in America are diagnosed with Alzheimer’s disease or related dementia. Most people with dementia live in a community setting and are cared for by a family member. Persons living with dementia almost universally experience behavioral and psychological symptoms (BPSD), such as agitation, aggression, and rejection of care as well as functional dependence. These symptoms are related to negative outcomes for both the person living with dementia and the family caregiver. Prior research shows that nonpharmacologic interventions such as meaningful activities, education, and multicomponent interventions have promise in managing behaviors. This symposium focuses on preliminary outcomes from the Dementia Behavior Study (DBS), a Randomized Control study that examined the effect of the Tailored Activity Program (TAP) in a community setting on BPSD and functional dependence in persons living with dementia, and caregiver wellbeing (e.g. depression, burden, perceived change). Gitlin et al will present outcomes of the primary aim (BPSD) and secondary aims (functional dependence and caregiver wellbeing) of the DBS. Pizzi et al explore the cost analysis of the TAP intervention versus the active control group. Scerpella et al describe the alerts and adverse events that were associated with the DBS. Marx et al present the relationship between race and caregiver readiness to participate in TAP. Regier et al explore the BPSD Rejection of Care and the association to caregiver burden. Tailoring interventions, such as activities may improve quality of life for both the person with dementia and the family caregiver.

1761P - Preparedness for caregiving in caregivers of cancer patients

BackgroundCaregiving a cancer patient is a complex role that involves new responsibilities for which caregivers don’t feel ready to provide care. Caregivers who feel unprepared for giving care have physical, psychological and social problems. It is necessary to determine all the needs of caregivers. MethodsThis is cross-sectional descriptive study was carried out with 203 Turkish cancer family caregivers at the oncology wards of six hospital from January-March 2019. We defined a caregiver as one of the family members who give most assistance. Data were collected with “Preparedness Scale of the Family Care Inventory”. The scale consists of eight items, total score range is 0-32. Higher scores indicate that the caregiver feels more prepared for their role. Data were evaluated by independent groups t test, one-way analysis of variance test. ResultsThe mean age of the caregivers was 46.8±13.8; most of them were female (64.5%); 68% of them felt constantly tired during the caregiving period; 55% had a decrease in social relations. Seventy one percent of the caregivers expressed that they wanted to know about the practices to protect their patients from infection; 64% of them wanted to know about what to do in case of emergency. Caregivers’ mean score from the scale was 27.0±6.0. Preparedness scores of those with high socioeconomic status are higher than those with low socioeconomic status (F=4.047; p=0.001). Less than one-year caregivers are more ready to provide care than caregivers for between one-five years; and between six-ten years caregivers are more ready to provide care than between one-five years (F=6.464; p=0.002). ConclusionsMeeting caregiving needs is associated with high socioeconomic status. It is expected result that high socioeconomic status is related to preparedness for caregiving. Less than one-year caregivers encounter less problems. Nurses need to recognize that ’new’ cancer caregivers may be feeling difficulty when the problem is encountered. Caregivers with more experience duration develop the ability to solve care problems as the time to care for cancer patients increases. Nurses need to recognize that caregivers often are ’experienced’ caregivers may be feeling burnout and ignore their own health-related problems. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

PATH-s: Predictive Validation of a Caregiving Preparedness Assessment Tool at 90-Days Post-Discharge from an IRF

The Preparedness Assessment for the Transition Home after Stroke (PATH-s) was developed to assess caregiver preparedness and provide actionable data for treatment planning. This is a follow-up study on the convergent and predictive validity of the PATH-s.

Living with advanced colorectal cancer: How prepared are informal caregivers to care for their loved ones?

179 Background: The ‘Living with Colorectal Cancer’ prospective cohort study seeks to characterize the experiences of patients diagnosed with advanced colorectal cancer and their caregivers, in order to inform care improvements. Here we describe informal caregivers’ perceived preparedness for caregiving. Methods: Eligible patients were identified by oncologists in Alberta, Canada’s two tertiary cancer centers. Consenting patients were given the option to invite a caregiver to participate. Caregivers’ preparedness for caregiving was assessed at enrollment and every 3 months thereafter using the Preparedness for Caregiving survey. This survey assesses levels of preparedness using 5-point Likert scales for 8 caregiving domains (e.g. caring for the patient’s physical and emotional needs, finding and setting up services, stress of caregiving, responding to emergencies), and one open-ended question. Results: In one year of recruitment, 55 caregivers in Calgary and Edmonton were enrolled, of which 65% were female, and 80% lived with the patient. Caregiver preparedness decreased over time from months 1 to 7 of follow-up, across all categories. Caregivers were least prepared for the stress of caregiving and caring for the patient’s emotional needs. They were most prepared for taking care of the patient’s physical needs at enrollment. Open-ended comments on specific preparedness needs were numerous and extensive. A range of topics were reported, the top three being: caregiver health (physical, mental, self-care), emotional aspects (preparing children and family, feeling alone) and end of life (hospice, palliative care, transitioning). Conclusions: Our data suggest that in the advanced cancer setting, caregiver perceived preparedness declines, with increasing stress and emotional distress over time. This may be related to patient illness progression. The open-ended qualitative comments on the Preparedness for Caregiving survey were particularly useful in understanding specific caregiver concerns. Caregiver experience, including sense of preparedness, is often under evaluated and this study suggests more attention is needed. Clinical trial information: NCT03572101.

Association of a Multidisciplinary Care Approach With the Quality of Care After Pediatric Tracheostomy

Incidence of tracheostomy placement in children is increasing, and these children continue to have high incidences of morbidity and mortality. A multidisciplinary tracheostomy program may help improve the quality of care received by these patients. To determine whether implementation of a multidisciplinary tracheostomy program can improve the care of children who received a tracheostomy through reduction in tracheostomy-related adverse events (TRAEs), improved tracheostomy education, and caregiver preparedness. A prospective cohort study was conducted from January 2015 to June 2018 at a pediatric tertiary referral center in Boston, Massachusetts. The participants included 700 children who had received a tracheostomy, most of whom were aged birth to 18 years, but some patients with congenital disorders were much older. Institution of a multidisciplinary tracheostomy team (MDT) whose activities included conducting staff meetings, organizing outpatient clinics, conducting inpatient tracheostomy ward rounds, and conducting inpatient tracheostomy rounds at a local rehabilitation hospital. Quality improvement initiatives included monitoring standardized TRAEs and distributing standardized tracheostomy "go-bags." Reduction of TRAEs and improved caregiver preparedness through distribution of tracheostomy go-bags were assessed following the establishment of a multidisciplinary tracheostomy program. In total, 700 children who had received a tracheostomy during the study period were actively followed up by the MDT. Of these children, 378 (54.0%) were males and 322 (46.0%) were females; mean (SD) age was 4.1 (6.1) years. More than 60 new pediatric tracheostomies were performed annually at the referral center. Reported TRAEs were reduced by 43.0% from the first to the third year after the implementation of a standardized, closed-loop monitoring system (from a mean [SD] of 6.1 [5.2] TRAEs per 1000 inpatient tracheostomy-days in 2015 to a mean [SD] of 4.0 [2.5] in 2018). The most common TRAE was unplanned decannulation, which occurred 64 times during the study period. On average, 10 patients were seen in each monthly multidisciplinary tracheostomy clinic. Clinic interventions included continuing care (146 [52.5%]), communication enhancement (67 [23.6%]), plans for decannulation (52 [18.6%]), and referrals for comorbidities (13 [4.6%]). Approximately 19 inpatients were seen during biweekly rounds and 8 during monthly rounds at a local rehabilitation hospital. A total of 297 patients received standardized tracheostomy go-bags, and more than 70 positive bag checks were performed in the monthly MDT clinics. A positive bag check refers to the incidence when a family is given a go-bag and also uses it. In contrast, a negative bag check refers to when a family is given a go-bag but neither brings it to the clinic nor acknowledges that they use it. This study's findings suggest that a multidisciplinary tracheostomy program may be a powerful tool for enhancing patient safety and quality improvement. Ongoing studies will develop measurable pediatric tracheostomy outcome metrics and assess long-term outcomes.

Effects of focused solving mode on the care preparedness and negative emotions of the main caregivers of patients with stroke

Objective To explore the effects of focused solving mode on the care preparedness and negative emotions of the main caregivers of patients with stroke. Methods Totally 87 main caregivers of patients with stroke were enrolled from the department of Neurology,North Jiangsu People′s hospital in Yangzhou from January 2018 to October 2018. Forty-three caregivers were recruited in the control group from January to May 2018. From June to October in 2018, 44 caregivers were recruited in the intervention group. Both groups received routine care, and the intervention group also received focused solving mode. Applying Caregiver Preparedness Scale、Self-rating Anxiety and Depression Scale to evaluate the effects of intervention. Two cases in intervention group were lost to follow-up while one case in control group. Results Before the intervention, there were no statistical differences in caregiver preparedness scores and anxiety and depression scores between two groups (P>0.05). After the implementation of the focused solving mode, the caregiver preparedness score was (24.14±3.25) points in the intervention group and (20.95±2.56) points in the control group, the difference was statistically significant (t=5.000, P<0.01); the anxiety and depression scores of caregivers were (47.64±6.54), (48.39 ±7.07) points in the intervention group, (50.33±4.68), (53.68±6.73) points in the control group, there were significant differences (t=-2.165,-3.511, P<0.05 or 0.01). Conclusion Focused solving mode can improve the care preparedness of the main caregivers of patients with stroke and alleviate anxiety and depression effectively. Key words: Focused solving mode; Stroke; Caregivers; Care preparedness; Anxiety; Depression

Relationship between caregiver preparedness and adults attachment among the spouse of young and middle-aged stroke patients

Objective To investigate the status of caregiver preparedness and adult attachment among the spouse of young and middle-aged stroke patients, and to analyze the correlation between them. Methods From January 2017 to May 2018, 110 spouses of stroke patients who were treated in Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine were selected as subjects by convenience sampling. The General Information Questionnaire, Care Preparedness Scale (CPS) , and Experience in Close Relationship Scale (ECR) were used in the survey. Totally 110 questionnaires were distributed, and 102 valid ones were retrieved, yielding an effective recovery rate of 92.73%. Results The total CPS score of 102 young and middle-aged stroke patients was (12.87±5.39) . The scores of attachment anxiety and attachment avoidance in ECR were (57.96 ±11.69) and (48.06 ±12.10) . There were statistically significant differences in the scores of preparedness of caregivers among spouse caregivers of different ages, self reported health status and nursing experience (P<0.05) . Attachment anxiety dimension was negatively correlated with caregiver preparedness score (r=-0.318, P<0.01) , and attachment avoidance dimension was negatively correlated with caregiver preparedness score (r=-0.233, P<0.01) . Conclusions The preparedness status of the spouses caregivers of young and middle-aged stroke patients are at a low level. Medical workers can improve their care preparedness by giving them home care knowledge guidance, reducing their attachment avoidance and attachment anxiety so as to improve their preparedness. Key words: Stroke; Young and middle-aged; Spouse; Caregiver preparedness; Adults attachment