Measuring the Impact of the Home Health Nursing Shortage on Family Caregivers of Children Receiving Palliative Care

The elderly are a growing surgical population with more comorbidities and less physiological reserve compared with nonelderly patients. The objective of our study was to implement a quality improvement pilot program targeting the specific needs of the elderly. We prospectively enrolled consecutive patients aged 65 years or older undergoing inpatient general or vascular surgery operations. Patients completed a preoperative assessment including the Vulnerable Elder Survey (VES) to determine baseline functional status and incidence of polypharmacy (five or more medications). They were interviewed postdischarge Day 2 and Day 30 for changes in functional status. An intervention was implemented consisting of an elderly-specific postoperative order set and preoperative risk reports sent to the surgical team with instructions to order physical therapy consults and home health nursing on discharge for VES 3 or greater and geriatrics consults for patients with polypharmacy. The elderly-specific order set was used for 71 per cent of the post-intervention group. There were no differences in the percentage of participants receiving physical therapy, geriatric, or home health nursing consults between the two groups. The postintervention group had significantly better functional status on postdischarge Day 30 ( P < 0.01). Our preliminary data suggest that individualizing care for elderly patients is feasible and may improve postoperative outcomes.

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Home Health Nursing Job Satisfaction and Retention

Nursing Clinics of North America ◽

10.1016/j.cnur.2019.11.002 ◽

2020 ◽

Vol 55 (1) ◽

pp. 121-132 ◽

Cited By ~ 2

Author(s):

Delores (Dede) J. McCreary

Keyword(s):

Job Satisfaction ◽

Home Health ◽

Home Health Nursing ◽

Health Nursing

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A conceptual model and key variables for guiding supportive interventions for family caregivers of people receiving palliative care

Palliative & Supportive Care ◽

10.1017/s1478951503030426 ◽

2003 ◽

Vol 1 (4) ◽

pp. 353-365 ◽

Cited By ~ 55

Author(s):

PETER HUDSON

Keyword(s):

Palliative Care ◽

Conceptual Model ◽

Family Caregivers ◽

Family Caregiver ◽

Intervention Development ◽

World Health ◽

The Family ◽

Key Variables ◽

Supportive Interventions ◽

The Impact

According to the World Health Organization, the patient and family should be viewed as the “unit of care” when palliative care is required. Therefore family caregivers should receive optimal supportive care from health professionals. However, the impact of supporting a dying relative is frequently described as having negative physical and psychosocial sequalae. Furthermore, family caregivers consistently report unmet needs and there has been a dearth of rigorous supportive interventions published. In addition, comprehensive conceptual frameworks to navigate the family caregiver experience and guide intervention development are lacking. This article draws on Lazarus and Folkman's seminal work on the transactional stress and coping framework to present a conceptual model specific to family caregivers of patients receiving palliative care. A comprehensive account of key variables to aid understanding of the family caregiver experience and intervention design is provided.

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Palliative medicine family conferences and caregiver psychological distress during prolonged mechanical ventilation

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2019-002103 ◽

2020 ◽

Vol 10 (4) ◽

pp. 443-451 ◽

Cited By ~ 1

Author(s):

Yi-Han Lee ◽

Jiao-Syuan Wang ◽

Randall Curtis ◽

Sheng-Jean Huang ◽

Shy-Shin Chang ◽

...

Keyword(s):

Mechanical Ventilation ◽

Palliative Care ◽

Family Caregivers ◽

Caregiver Burden ◽

Psychological Symptoms ◽

Prolonged Mechanical Ventilation ◽

Event Scale ◽

Quality Of Dying ◽

Care Family ◽

The Impact

ObjectivesLittle is known about the experience of family caregivers of patients who require prolonged mechanical ventilation (PMV). We examined the perspectives of caregivers of patients who died after PMV to explore the role of palliative care and the quality of dying and death (QODD) in patients and understand the psychological symptoms of these caregivers.MethodsA longitudinal study was performed in five hospitals in Taipei, Taiwan. Routine palliative care family conferences and optional consultation with a palliative care specialist were provided, and family caregivers were asked to complete surveys.ResultsIn total, 136 family caregivers of 136 patients receiving PMV were recruited and underwent face-to-face baseline interviews in 2016–2017. By 2018, 61 (45%) of 136 patients had died. We successfully interviewed 30 caregivers of patients’ death to collect information on the QODD of patients and administer the Impact of Event Scale (IES), Hospital Anxiety and Depression Scale (HADS) and Center for Epidemiologic Studies Depression (CES-D) scale to caregivers. We observed that more frequent palliative care family conferences were associated with poorer QODD in patients (coefficients: −44.04% and 95% CIs −75.65 to −12.44), and more psychological symptoms among caregivers (coefficient: 9.77% and 95% CI 1.63 to 17.90 on CES-D and coefficient: 7.67% and 95% CI 0.78 to 14.55 on HADS). A higher caregiver burden at baseline correlated with lower psychological symptoms (coefficient: −0.35% and 95% CI −0.58 to −0.11 on IES and coefficient: −0.22% and 95% CI −0.40 to −0.05 on CES-D) among caregivers following the patients’ death. Caregivers’ who accepted the concept of palliative care had fewer psychological symptoms after patients’ death (coefficient: −3.29% and 95% CI −6.32 to −0.25 on IES and coefficient: −3.22% and 95% CI −5.24 to −1.20 on CES-D).ConclusionsPalliative care conferences were more common among family members with increased distress. Higher caregiver burden and caregiver acceptance of palliative care at baseline both predicted lower levels of caregiver distress after death.

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