Caregiving Skills Research Articles

Improvements in Heart Rate Variability among Dementia Family Caregivers Receiving a Home‐Visit Based Intervention: Preliminary Results from a Randomized Controlled Trial

AbstractBackgroundEmotional stress of family caregivers of persons with dementia (PWD) is often a topic of concern, as many experience negative health outcomes resulting from their years‐long caregiving role. A home‐visit based educational intervention focused on improving caregiving skills and managing stress was delivered to ethnically diverse dementia family caregivers in California in their preferred language. Previously, survey data were used to evaluate caregivers’ stress and well‐being. However, there might be limitations in using survey instruments to measure stress among diverse caregivers with limited English proficiency. Data collected via wearable technology (e.g., smartrings) can objectively measure stress in the form of Heart Rate Variability (HRV). We examined the intervention’s effect on stress levels measured by HRV among diverse dementia family caregivers using wearable technology.MethodsThe study design was a randomized controlled trial. Family caregivers of community dwelling PWD identifying as either Korean, Vietnamese, Hispanic/Latino, or Non‐Hispanic White were recruited through community outreach. Participants were randomly assigned with a 2:1 ratio to either the intervention group (IG) receiving language‐specific home‐visit based education or the attention control group (AG) receiving only care resource information. All participants wore smartrings monitoring HRV for 3 months. We used linear mixed models to assess the differences in HRV between the two groups using random intercept and slope for intervention, controlling for the covariates (age, gender, relationship, cohabitation, ethnicity, education).ResultsHRV data was collected from 59 caregivers (69% IG and 31% AG). Demographics included: 20 Korean (33.9%), 17 Vietnamese (28.8%), 10 Hispanic (17%), 12 Non‐Hispanic White (20.3%); 32 spouses (54%), 27 off‐spring (46%); 45 females (76%), ages 34 to 87 years (mean = 65.3, SD = 13.6). The linear mixed models showed a significant improvement in stress (higher HRV indicating better stress management) among IG caregivers compared to the AG caregivers over time (Beta coefficient = .079, P‐value = .032).ConclusionsMeasuring stress using smartrings was feasible and effective to track stress levels among diverse caregivers. Preliminary analyses suggest the home‐visit based intervention may have a positive effect on stress in ethnically diverse family caregivers of PWD compared to those only provided with care resource information.

Maya Angelou Center for Health Equity Caregiver College: a culturally‐relevant training for African American Alzheimer’s disease caregivers

AbstractBackgroundAfrican American (AA) caregivers of patients with Alzheimer’s disease (AD) and related disorders can play a critical role in maintaining patient health. The Maya Angelou Center for Health Equity at Wake Forest University School of Medicine Caregiver College (MC2) aims to (1) improve informal caregivers’ knowledge of AD and related disorders, (2) enhance the quality of life for AD patients and caregiver’s by providing awareness of and access to resources that can help reduce caregiver burden, (3) provide strategies to effectively manage patient symptoms associated with AD, and (4) fill gaps in culturally relevant health education and awareness on AD, brain health, and dementia caregiving skills for AAs.MethodThe 40‐hour inaugural session of MC2 was conducted in‐person in October 2022. Educational sessions were facilitated by experts in various fields including AD, social work, nursing, aging, nutrition, and pharmacy. Topics covered over the course of the educational week included: Alzheimer’s Disease Overview, Health Disparities in AAs, Risk Factors for AD, End of Life Planning, and Caregiver Health. The 21‐item Dementia Knowledge Assessment Tool (DKAT), version 2 (Toye, et al. 2013) was used to track changes in AD knowledge and awareness. A DKAT pre‐test was administered before the educational sessions began on Day 1, and a post‐test assessment was administered at the end of the last educational session on Day 5.ResultAttendees (N = 21) are African American (100%), primarily female (90.48%), with an average age of 66.8 years (range 42‐82 years, 1 missing value). DKAT assessments from the week‐long educational training, showed an 8% increase in knowledge about AD in this sample of dementia caregivers based on a 5.7 percentage point increase on the DKAT from an average of 71.4% correct pre‐training to an average of 77.1% correct post‐training.ConclusionFindings suggest that community‐based educational training is a useful strategy for improving AD knowledge and resource awareness for AA informal caregivers. Results will be used to expand this training to include community members who will be engaged through presentations by attendees of the MC2.

‘It’s a lonely journey’: caregiving experiences and psychosocial distress among Chinese American dementia family caregivers

Objectives Chinese American family caregivers of persons with Alzheimer’s disease and related dementia (ADRD) are a vulnerable but understudied population. The goal of this qualitative study was to examine their caregiving experiences and psychosocial distress process and explore intervention strategies. Methods In-depth individual interviews were conducted with 18 Chinese American dementia caregivers. All interviews were transcribed verbatim; thematic content analysis was conducted to construct a conceptual framework. Results All participants reported high levels of caregiving stress associated with care-recipients’ advanced symptoms and required assistance in activities in daily living. The relationship of caregiver and care-recipient was strained in their roles transition. The complex healthcare system, insurance policies, and a lack of linguistically appropriate services aggravated their psychosocial distress. Chinese cultural norms on ‘family harmony’ hindered their seeking of social support. Prolonged caregiving stress led to physical and mental impairment, including poor sleep, depression, and chronic conditions. Participants described their caregiving experience as ‘a lonely journey’ with a pervasive sense of hopelessness and withdrawal; their distress process was positively or negatively influenced by their coping strategies. All participants were eager for any kind of support; especially culturally appropriate programs that could improve their caregiving skills, self-care, and access to services. Conclusion Our data suggest that Chinese American dementia caregivers, especially those with limited English proficiency, experience elevated psychosocial distress, which was aggravated by the barriers to social support and health services due to their immigrant and minority status. Culturally appropriate targeted intervention is urgently needed for this underserved and vulnerable population.

A short report on a preliminary interventional study to evaluate play-mediated interaction skills in caregivers of children with autism spectrum disorder from Sri Lanka.

Most children with autism spectrum disorder live in low- and middle-income countries. Most of them do not have access to timely and culturally acceptable interventions. Research from high-income countries and low- and middle-income countries, such as Sri Lanka, show that parent-mediated intervention programmes improve functional outcomes, highlighting the importance of parents as partners. We undertook a preliminary study to evaluate how play-based parent coaching will enhance the parent interaction skills to promote social-emotional, cognitive and language skills in children with autism spectrum disorder aged 2-4 years. We evaluated how parents acquire interaction skills to engage with children using a caregiver skills assessment checklist adapted from freely accessible resources. Before and after training, all parent-child dyads participated in a 10-min video-recorded play session with a set of toys of their choice. Over the course of 2 weeks, all parents spent 2 h/day playing and interacting with the child to harness the desired skills. The results showed that the parental training had a positive effect on all 30 caregivers in gaining skills, with a significant improvement in all three domains with the highest impact on skills for social-emotional development. Overall, parents reported high levels of satisfaction on the training. The significant improvement in parent interaction skills was promising. However, further studies to look at the sustainability of the skills and the impact on children's overall development need to be looked into using larger and more generalised studies.

Navigating the terrain of caregiving of children with intellectual and developmental disabilities: importance of benefit finding and optimism

Empirical studies have indicated that benefit finding and optimism greatly help caregivers of children with intellectual or developmental disabilities. Specifically, it has been suggested that these two constructs serve as critical coping strategies for those engaged in the caregiving process. Here, a qualitative study was undertaken to explore the impacts of benefit finding and optimism on caregivers of children with intellectual and developmental disabilities in Malaysia. Twenty (20) caregivers of children with intellectual and developmental disabilities were interviewed concerning their perception and use of benefit finding and optimism. Results identified these strategies as supporting and guiding caregiving responsibilities and skills, improving personal growth, relationships and spirituality, as well as increasing positive perceptions. Therefore, policymakers and stakeholders in Malaysia should implement targeted interventions to facilitate and support caregivers in applying benefit-finding and optimism in their caregiving, thereby assisting them to better cope with the physical and mental demands of caring for children with intellectual and developmental disabilities.

Improving Behavioural and Social Skills in Children with Down Syndrome through Parent-Child Interaction Therapy: Effects on Parenting Skills and Stress in Caregivers

This study aimed to shed light on the available intervention tools for children with Down syndrome and their caregivers. Based on evidence gathered from past research, four hypotheses were formed which were tested by four different standardized tests along with Dyadic Parent-Interaction Coding System (DPICS). The research is based on a randomized experimental design checking the pre-post efficacy of the treatment. Out of all of the hypotheses, two showed statistical significance, which showed the impact of Parent-Child Interaction Therapy (PCIT) on the disruptive behaviour of children with Down syndrome and the caregiver skills of their parents. However, it showed statistical significance in the subscales of autonomy and empathy in the social skills of Down syndrome and showed no statistical significance on parental stress.

Health care needs, eHealth literacy, use of mobile phone functionalities, and intention to use it for self-management purposes by informal caregivers of children with burns: a survey study

BackgroundThis study aimed to assess health care needs, electronic health literacy, mobile phone usage, and intention to use it for self-management purposes by informal caregivers of children with burn injuries.MethodsThis cross-sectional research was carried out in 2021 with 112 informal caregivers of children with burns in a burn center in the north of Iran. The data collection tools were questionnaires that included the participants’ demographics, their E-Health Literacy, their current mobile phone usage, and their desires for mobile phone use for burn care services.ResultsMost informal caregivers had smartphones (83.0%) and Internet access (81.3%). Most participants occasionally used phone calls (63.4%), the Internet (45.5%), and social media (42.9) to receive information about psychosocial disorders, infection control, wound care, pain, itch, physical exercise, and feeding. Most participants have never used some of the mobile phone functionalities to receive burn-related information, such as applications/Software (99.1%) and e-mail (99.1%). Nevertheless, most informal caregivers desire to use mobile applications for self-management purposes in the future (88.4%). The mean eHealth literacy score was 25.01 (SD = 9.61). Informal caregivers who had higher education levels, access to the Internet, and lived in urban areas had higher eHealth literacy (P < 001).ConclusionThe current research delivers beneficial information about the healthcare needs of informal caregivers and their preference to use mobile functionality to receive burns-related healthcare and rehabilitation information post-discharge. This information can help design and implement mobile health (mHealth) interventions to enhance the self-care skills of informal caregivers.

Caregiver skills training for caregivers of individuals with neurodevelopmental disorders: A systematic review and meta-analysis.

To systematically review the effectiveness of caregiver and parent skills training programs, including caregiver-mediated interventions, for caregivers of individuals with neurodevelopmental disorders. We conducted a systematic review with a random-effects meta-analysis. We searched 11 electronic databases through July 2021 and used a snowball methodology to locate relevant articles of randomized controlled trials. Effect size estimates were pooled using Hedges' g from data extracted from study reports and through author requests using random-effects meta-analyses for three child outcome categories (child development, adaptive behavior, and problem behavior) and three caregiver outcome categories (parenting skills and knowledge, psychological well-being, and interpersonal family relations). We located 44 910 records, from which 75 randomized controlled trials involving 4746 individuals with neurodevelopmental disorders and their caregivers were included. Random-effects meta-analyses showed improvements in child development (g = 0.30; 99% confidence interval [CI] = 0.07-0.53) and reduction in reported problem behaviors (g = 0.41; 99% CI = 0.24-0.59), but not a statistically significant improvement in adaptive behavior (g = 0.28; 99% CI = -0.42 to 0.98). Caregivers showed improvements in parenting skills and knowledge (g = 0.72; 99% CI = 0.53-0.90), psychological well-being (g = 0.52; 99% CI = 0.34-0.71), and interpersonal family relations (g = 0.76; 99% CI = 0.32-1.20). Caregiver skills training programs benefit both caregivers and children with neurodevelopmental disorders. Skills training programs improve child development and behavior, improve parenting skills, reduce caregiver mental health issues, and improve family functioning. Programs using culturally appropriate training material to improve the development, functioning, and participation of children within families and communities should be considered when caring for children with neurodevelopmental disorders. Caregiver skills training programs are effective interventions for both caregivers and children. Children with neurodevelopmental disorders benefit from improvements in development and reduction of problematic behaviors. Caregivers benefit from enhanced skills and psychological well-being. Improvements in interpersonal family relationships have also been documented.

52.3 Integrating Caregiver Skills and Support in a Partial Hospitalization Program

52.3 Integrating Caregiver Skills and Support in a Partial Hospitalization Program

Can collaboration among health and social care workers play a role in addressing geriatric care challenges? A qualitative case study in Central Vietnam.

Vietnam's healthcare system offers limited services and facilities for older adults. This study explored the perceptions of health and social care workers regarding geriatric care issues, their impact on older adults and the potential of collaboration for enhancing older adults' health and well-being. This qualitative case study employed 27 focus group discussions and two in-depth interviews with 174 participants in Thua Thien Hue Province, Vietnam. An inductive thematic analysis was conducted. According to the participants, the major challenges that hindered geriatric care consisted of caregiver and care recipient issues, which were identified to constrain care accessibility, resulting in decreased physical, mental and social health. Across different settings and professions, collaboration was considered a routine and natural aspect of daily work. It was perceived that establishing and strengthening collaboration could facilitate improvement in health and social welfare services through the prioritization of needs and enhancement of caregiver skills and training. Collaboration was viewed as ad hoc but indispensable for addressing the identified geriatric care issues that could improve the general health and well-being of older adults. The findings indicate a need for better collaboration in Vietnam, achieved through defined guidelines, training and improved interprofessional education and practice.

Transition to the Role of Family Caregiver of Older Adults After a Stroke: A Specific Theory

Introduction: Nursing professionals develop situation-specific theories to describe, explain, and provide comprehensive care during a family member’s transition to the caregiver role. Objective: To develop a situation-specific theory about the transition to the role of family caregiver of older adults after a stroke. Methodology: The integrating approach by Meleis and Im was applied, which consists of five stages: 1) Description of the context and target population, 2) Verification of assumptions regarding the philosophical stance, 3) Exploration of multiple sources, 4) Theorization of concepts, and 5) Proposal of empirical indicators for validation and verification. Results: The prescriptive theory was developed in the light of Afaf Meleis’ Theory of Transitions and was supported by an exhaustive literature review, with four underlying concepts: Situational transition to the family caregiver role, Care-related knowledge and skills, Self-confidence and coping in adopting the caregiver role, and Nursing therapeutic education. The following assumption emerges from these concepts: a healthy transition to the family caregiver role is directly dependent on the care-related knowledge and skills provided by Nursing therapeutic education to develop self-confidence and coping in adopting the caregiver role. Conclusions: The proposal provides a conceptual framework that identifies the transition challenges and needs faced by family caregivers to adopt the role of caregivers of older adults after a stroke.

Predicting unmet activities of daily living needs among the oldest old with disabilities in China: a machine learning approach.

The ageing population in China has led to a significant increase in the number of older persons with disabilities. These individuals face substantial challenges in accessing adequate activities of daily living (ADL) assistance. Unmet ADL needs among this population can result in severe health consequences and strain an already burdened care system. This study aims to identify the factors influencing unmet ADL needs of the oldest old (those aged 80 and above) with disabilities using six machine learning methods. Drawing from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2017-2018 data, we employed six machine learning methods to predict unmet ADL needs among the oldest old with disabilities. The predictive effects of various factors on unmet ADL needs were explored using Shapley Additive exPlanations (SHAP). The Random Forest model showed the highest prediction accuracy among the six machine learning methods tested. SHAP analysis based on the Random Forest model revealed that factors such as household registration, disability class, economic rank, self-rated health, caregiver willingness, perceived control, economic satisfaction, pension, educational attainment, financial support given to children, living arrangement, number of children, and primary caregiver played significant roles in the unmet ADL needs of the oldest old with disabilities. Our study highlights the importance of socioeconomic factors (e.g., household registration and economic rank), health status (e.g., disability class and self-rated health), and caregiving relationship factors (e.g., caregiver willingness and perceived control) in reducing unmet ADL needs among the oldest old with disabilities in China. Government interventions aimed at bridging the urban-rural divide, targeting groups with deteriorating health status, and enhancing caregiver skills are essential for ensuring the well-being of this vulnerable population. These findings can inform policy decisions and interventions to better address the unmet ADL needs among the oldest old with disabilities.

The Effects of a Blended Care Intervention in Partners of Patients With Acquired Brain Injury – Results of the CARE4Carer Randomized Controlled Trial

ObjectiveTo assess effects of the CARE4Carer blended care intervention on caregiver mastery and psychosocial functioning compared with usual care in partners of patients with acquired brain injury (ABI). DesignMulticenter randomized controlled trial. SettingNine sites for rehabilitation medicine. Participants120 partners of outpatients with ABI were randomly allocated to blended care (N=59) or usual care (N=61). InterventionThe blended care intervention (20 weeks) was aimed at improving caregiving skills and consisted of 9 online sessions, combined with 2 face-to-face consultations with a social worker. Main Outcome MeasuresMastery was assessed with the Caregiver Mastery Scale, secondary outcome measures were caregiver strain (Caregiver Strain Index), family functioning (Family Assessment Device), anxiety and depression (Hospital Anxiety and Depression Scale), burden (self-rated), and quality of life (CarerQol). Assessments were performed at baseline, 24, and 40 weeks. ResultsThe adjusted mean difference in caregiver mastery between intervention and control group at week 24 was 1.31 (SD3.48, 95% confidence interval (CI) -0.12 to 2.74, P=.072) and at week 40 was 1.31 (SD3.69, 95% CI -0.26 to 2.88, P=.100). In the per protocol analysis, the adjusted mean difference in caregiver mastery at week 24 was 1.53 (SD3.38, 95% CI 0.10 to 2.96, P=.036) and at week 40 was 1.57 (SD3.63, 95% CI 0.01 to 3.14, P=.049). Regarding secondary outcomes, caregiver strain was lower in the intervention group in the per protocol analysis at week 40. Family functioning was higher in the intervention group in week 24, whereas anxiety was lower at both timepoints. ConclusionsIn the subset of participants who were able to complete the intervention, caregiver mastery and psychosocial functioning improved. Future work should focus on improving adherence as this will optimize beneficial effects of blended care.

Urgent needs of caregiving in ageing populations with Alzheimer's disease and other chronic conditions: Support our loved ones.

The ageing process begins at birth. It is a life-long process, and its exact origins are still unknown. Several hypotheses attempt to describe the normal ageing process, including hormonal imbalance, formation of reactive oxygen species, DNA methylation & DNA damage accumulation, loss of proteostasis, epigenetic alterations, mitochondrial dysfunction, senescence, inflammation, and stem cell depletion. With increased lifespan in elderly individuals, the prevalence of age-related diseases including, cancer, diabetes, obesity, hypertension, Alzheimer's, Alzheimer's disease and related dementias, Parkinson's, and other mental illnesses are increased. These increased age-related illnesses, put tremendous pressure & burden on caregivers, family members, and friends who are living with patients with age-related diseases. As medical needs evolve, the caregiver is expected to experience an increase in duties and challenges, which may result in stress on themselves, and impact their own family life. In the current article, we assess the biological mechanisms of ageing and its effect on body systems, exploring lifestyle and ageing, with a specific focus on age-related disorders. We also discussed the history of caregiving and specific challenges faced by caregivers in the presence of multiple comorbidities. We also assessed innovative approaches to funding caregiving, and efforts to improve the medical system to better organize chronic care efforts, while improving the skill and efficiency of both informal and formal caregivers. We also discussed the role of caregiving in end-of-life care. Our critical analysis strongly suggests that there is an urgent need for caregiving in aged populations and support from local, state, and federal agencies.

Barriers and Support for Family Caregivers in Caring for Older Adults with Dementia: A Qualitative Study in Indonesia

Background: Understanding the barriers and support that family caregivers face when caring for older adults with dementia is critical for improving the quality of dementia care. However, research in this area remains limited in Indonesia. Purpose: This study aimed to explore the barriers and support for family caregivers in caring for older adults with dementia in Indonesia.Methods: A descriptive phenomenological study was conducted among 15 family caregivers who cared for older adults with dementia. Purposive sampling was used to recruit the participants. Inclusion criteria included primary family caregivers who provided care for four hours per day for at least six months, were proficient in Indonesian, assisted older adults in daily activities, and were capable of expressing their experiences. Data were collected using in-depth semi-structured interviews and analyzed using the Colaizzi method. Results: This study found that family caregivers faced barriers during the care of older adults with dementia, which have decreased the quality of care. These barriers included inadequate knowledge and skills of family caregivers regarding dementia, stigma, lack of knowledge and awareness in the community, limited availability of healthcare services, and healthcare professionals’ lack of knowledge about dementia. On the other hand, support received by family caregivers within the family, support from other family caregivers, and education provided by NGOs about caring for someone with dementia have shown a positive impact in reducing the burden on caregivers and improving the quality of care. Therefore, appropriate support is essential for family caregivers caring for older adults with dementia.Conclusion: This study showed that barriers originating from family caregivers, community awareness, access to health services, and barriers from health workers have impacted poor quality of care, while the support of families, fellow family caregivers, and NGOs have contributed to good quality of care. Further studies are needed to explore the perspectives of family caregivers representing different cultures in Indonesia.

The Unmet Needs of Caregiving Skills, Support, Emotions, and Finances of Stroke Caregivers: A Multicenter Study.

​​​​​​Background Informal stroke caregivers in Malaysia play an important role in supporting stroke survivors following acute care. Nevertheless, there is a lack of available data to inform the sufficiency of help and resources available to address the needs of local stroke caregivers. This study aimed to determine the unmet needs in caregiving skills, support, emotions, and finances as well as the associated factors of stroke caregivers in Malaysia. Methodology This multicenter, cross-sectional study used a self-administered survey developed and validated for the Malaysian population. It was prepared in paper-based and web-based formats, and it was distributed via direct contact with the respondents, post, and email. Respondents were recruited from different sites in Malaysia. In this study, unmet needs were defined as "help that was needed more or was not provided to assist caregivers and address their specific needs." This article only presents the quantitative data of this study. Data were analyzed using descriptive analysis and logistic regression to determine factors associated with unmet needs. Results Almost all study respondents (91%) reported having unmet needs. Unmet needs ranged from 1 to 10, while the mean unmet needs was 5. The highest unmet need was related to financial support (72.5%), followed by support from professionals to address their own needs (59.2%), skills to care for stroke survivors, i.e., skills in caring for stroke survivors with their daily activities (57.9%), and skills in supporting stroke survivors to perform rehabilitation at home (53.1%). The lowest unmet need was related to support in transporting stroke survivors from place to place (45.3%). Additionally, this study did not identify an association between the reported unmet needs and gender, age, ethnicity, duration of caregiving, and site of participation. Conclusions This study reported a range of unmet needs perceived by stroke caregivers in Malaysia. Further research is warranted to understand the gaps in supporting local stroke caregivers to inform future post-stroke support and services in the country.

Development of capacitive seating analysis sensor using conductive textile for the evaluation of seating motion

AbstractIn this study, we developed a capacitive seating analysis sensor using a conductive textile for evaluating a Seating Motion. Physical burden on caregivers is a common problem at nursing care sites. Developing long‐term caregiving skills can help reduce the physical burden on amateur caregivers. Several quantitative evaluation studies have focused on the skills of caregivers. However, such evaluation is highly expensive and require huge area because it involves the use of motion capture systems with several 3D cameras for dynamic motion analysis. In our previous study, we developed a conductive textile sensor for measuring the seating position of a care recipient in a wheelchair. The sensor could measure either seating body pressure or distance between the buttocks and the seat. The system can measure the care recipient's motion without requiring any motion capture system. We recommend using the sensor to evaluate the skills of caregivers; the sensor output can be used to determine the seating speed of the care recipient on the chair. Herein, we report the validity of the measurement system comprising a conductive textile–based capacitive seating analysis sensor for evaluating seating in nursing care.

Does Regular Practice with a "Flexible Bronchoscopy Simulator" Improve Fibreoptic Intubation Skills in Experts and Novices? A Randomized Controlled Study.

The appropriate management of a "difficult airway" remains a challenge for novices and experienced anaesthetists. With the current available airway technologies, e.g., video laryngoscopy, flexible bronchoscopy (fibreoptic intubation (FOI)) for endotracheal intubation is decreasing, likely diminishing caregiver skills. We investigated whether bronchoscopy simulator training improved FOI skills. 72 volunteers, consisting of anaesthetists, anaesthesia residents, and nurses, performed six exercises on a bronchoscopy simulator. At baseline and after 12 months, the six exercises included one serious game (to train agility), two basic airways, and three difficult airways. After a baseline assessment, subjects were randomly allocated to the intervention group (with) or control group without bronchoscopy simulator training every six weeks for 10 min using a preloaded serious game. The primary outcome was the difference in the time to reach the carina after 12 months, as measured objectively by the simulator. The level of stress and FOI confidence after 12 months were secondary outcomes. The control and intervention groups had a similar time to reach the carina in difficult airway cases and the reported stress levels, at baseline and 12 months, showed no difference. In contrast, the intervention group's self-reported confidence in FOI skills improved more. Although participants rated higher in confidence, practicing FOI skills on an airway simulator with an agility game did not increase their performance in simulated challenging airway instances.

Dependency Care in a Politically Liberal Society

AbstractCaregiving is crucial for any society; however, it often goes unnoticed and unanalyzed within theories of justice. Asha Bhandary's theory of liberal dependency care seeks to both rectify the invisibility of care and defend principles of justice for caregiving arrangements by arguing for several important modifications to John Rawls's theory of justice. In this article, I analyze Bhandary's modifications to Rawls's theory to consider how well liberal dependency care fits into a broader political liberal framework, while still securing protection against oppression. I also evaluate the permissibility and limits of teaching children autonomy and caregiving skills in a politically liberal society.

Fathers in the spotlight: parental burden and the effectiveness of a parental skills training for anorexia nervosa in mother–father dyads

PurposeResearch on the engagement of fathers in the treatment of childhood psychiatric disorders is scarce. This study aims to investigate differences between mothers and fathers of adolescents with anorexia nervosa regarding parental burden and effectiveness of a parental skills training.MethodsNinety-one mother–father dyads caring for a child with anorexia nervosa participated in an 8-week parental skills training and completed a set of questionnaires assessing parental psychopathology, eating disorder related burden, caregiver skills and expressed emotion at baseline and post-intervention.ResultsFathers showed lower levels of general psychological distress, depression, anxiety and eating disorder related burden as well as lower emotional overinvolvement compared to mothers. The skills training was effective in reducing parental psychopathology, eating disorder-related burden and emotional overinvolvement as well as in increasing caregiver skills with no differences between mothers and fathers. However, session adherence and the willingness to practice skills between the sessions were slightly lower in fathers.ConclusionsThese findings show that fathers are a great resource for the child’s eating disorder treatment as they may counterbalance maternal emotional overinvolvement and over-protection. Furthermore, this is the first study demonstrating that fathers can profit from a parental skills training for anorexia nervosa in a similar way as mothers.Level IIIEvidence obtained from well-designed cohort or case–control analytic studies.