scholarly journals Women’s Caregiving Experience of Older Persons Living With Alzheimer Disease and Related Dementias and Multiple Chronic Conditions: Using Wuest’s Theory

2020 ◽  
Vol 6 ◽  
pp. 237796082097481
Author(s):  
Shelley Peacock ◽  
Melanie Bayly ◽  
Wendy Duggleby ◽  
Jenny Ploeg ◽  
Lori Pollard ◽  
...  
Keyword(s):  
Alzheimer Disease ◽  
Health Care Providers ◽  
Chronic Conditions ◽  
Active Role ◽  
Qualitative Description ◽  
Control Group ◽  
Multiple Chronic Conditions ◽  
Care Providers ◽  
Web Based

Introduction Care of persons living with chronic conditions rests heavily on women within the context of the family. Research demonstrates that women experience more caregiving strain compared to men, yet less is known about the differences in experiences between women carers: namely, wives and daughters. Objective The purpose of this study was to examine and compare the experiences of wife and daughter carers of older adults living with Alzheimer disease and related dementias, plus at least two other chronic conditions. Methods Using qualitative description with Wuest’s feminist caring theory of precarious ordering as an analytic framework, interview transcripts of women carer participants who were from the control group of a larger multi-site mixed methods study evaluating the web-based intervention My Tools 4 Care were analyzed. Findings Both wives and daughters experienced daily struggles, altered prospects, and ambivalent feelings around their caring role. Negotiating the role of professional carer was an important part of balancing caring demands and anticipating the future, and women took an active role in trying to harness caring resources. Findings indicated wives and daughters were generally similar in how they described their caregiving, although daughters reported more shared caring and decision-making, and needed to balance paid employment with caregiving. Conclusion Wives and daughters face similar challenges caring for persons with a dementia and multiple chronic conditions, and actively engage in strategies to manage caring demands. The findings illuminate the importance of accessible, appropriate support from professional carers/health care providers, and suggest that assistance navigating such supports would benefit women carers.

scholarly journals Transition Experiences of Caregivers of Older Adults With Dementia and Multiple Chronic Conditions: An Interpretive Description Study

2020 ◽  
Vol 6 ◽  
pp. 237796082093429
Author(s):  
Annie Lam ◽  
Jenny Ploeg ◽  
Sandra L. Carroll ◽  
Wendy Duggleby ◽  
Carrie McAiney ◽  
...  
Keyword(s):  
Health Care ◽  
Family Caregivers ◽  
Health Care Providers ◽  
Social Life ◽  
Chronic Conditions ◽  
Community Dwelling ◽  
Multiple Chronic Conditions ◽  
Interpretive Description ◽  
Care Providers ◽  
Transition Experiences

Introduction Family caregivers provide most of the care for older persons living with dementia (PLWD) and multiple chronic conditions (MCCs) in the community. Caregivers experience transitions, such as changes to their health, roles, and responsibilities, during the process of caring. Transitions encompass a time when caregivers undergo stressful responses to change. However, we know little about the transition experiences of caregivers of persons living with both dementia and MCCs. Objective This qualitative study explored the transition experiences of caregivers of PLWD within the context of MCCs, from the perspective of both caregivers and practitioners. The research question was the following: What are the transition experiences of family caregivers in providing care to older PLWD and MCCs living in the community? Methods This study was conducted using an interpretive description approach. Semistructured interviews were conducted with 19 caregivers of older community-dwelling PLWD and MCCs and 7 health-care providers working with caregivers in Ontario, Canada. Concurrent data collection and inductive data analysis were used. Results Caregivers of older PLWD and MCCs experienced four key transitions: (a) taking on responsibility for managing multiple complex conditions, (b) my health is getting worse, (c) caregiving now defines my social life, and (d) expecting that things will change. Findings highlight how the coexistence of MCCs with dementia complicates caregiver transitions and the importance of social networks for facilitating transitions. Conclusion The study provided insight on the transition experiences of caregivers of older PLWD and MCCs. MCCs increased the care load and further complicated caregivers’ transition experiences. Health-care providers, such as nurses, can play important roles in supporting caregivers during these transitions and engage them as partners in care.

Chronic Health Care

2009 ◽  
Vol 22 (1) ◽  
pp. 43-48
Author(s):  
Brenda Scruggs
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Active Role ◽  
Illness Management ◽  
Positive Outcomes ◽  
Care Providers ◽  
Chronic Health ◽  
Acute Health Care ◽  
Acute Injuries

The traditional acute health care model works well for acute injuries and illnesses but is unlikely to achieve good outcomes in managing chronic health care conditions. Positive outcomes in chronic illness management requires multiple referrals from the primary care provider for a multidisciplinary team, relinquished control by the health care providers as they coach the patient into the active role of self-care life skills and daily management of their health, and active learning, participation, and accountability of the patient.

scholarly journals Physician Specialty and Office Visits Made by Adults With Diagnosed Multiple Chronic Conditions: United States, 2014-2015

2020 ◽  
Vol 135 (3) ◽  
pp. 372-382
Author(s):  
Brian W. Ward ◽  
Kelly L. Myrick ◽  
Donald K. Cherry
Keyword(s):  
Health Care Providers ◽  
Chronic Conditions ◽  
Multiple Chronic Conditions ◽  
Care Providers ◽  
Office Visits ◽  
Physician Specialty ◽  
Physician Office ◽  
Care Survey ◽  
Nationally Representative ◽  
Ambulatory Medical Care

Objectives Adults with multiple chronic conditions (MCCs; ≥2 chronic conditions) account for a substantial number of visits to health care providers. The complexity of a patient’s care, including the number of chronic conditions, may differ by physician specialty. The objectives of this study were to (1) examine differences in physician office visits among adults with MCCs by physician specialty and (2) identify the types of MCC dyads (combinations of 2 chronic conditions) most common among visits to office-based physicians. Methods We used data from the 2014-2015 National Ambulatory Medical Care Survey (unweighted analytic sample, n = 61 682), a nationally representative survey of physician office–based ambulatory visits, to examine differences in physician office visits among adults with MCCs by physician specialty. We also identified the most commonly observed MCC dyads among these visits. Results During 2014-2015, 40.0% of physician office visits were made by adults with MCCs. Compared with visits for all specialties combined (40.0%), a significantly higher percentage of physician office visits among adults with MCCs were to specialists in cardiovascular disease (74.7%) and internal medicine (57.6%). For all physician specialties except psychiatry, the MCC dyads of hyperlipidemia and hypertension and diabetes and hypertension were among the most commonly observed MCC dyads among visits made by adults with MCCs. Conclusions Awareness of these findings may help specialists improve care for adults with MCCs. The recognition among physicians of common MCC dyads is relevant to the care management of persons with MCCs.

scholarly journals A Web-Based Intervention to Help Caregivers of Older Adults With Dementia and Multiple Chronic Conditions: Qualitative Study (Preprint)

2017 ◽  
Author(s):  
Jenny Ploeg ◽  
Carrie McAiney ◽  
Wendy Duggleby ◽  
Tracey Chambers ◽  
Annie Lam ◽  
...  
Keyword(s):  
Older Adults ◽  
Alzheimer Disease ◽  
Chronic Conditions ◽  
Emotional Health ◽  
Community Dwelling ◽  
Multiple Chronic Conditions ◽  
Web Based ◽  
Roles And Responsibilities ◽  
Study Results ◽  
Caregiving Roles

BACKGROUND Caregivers (ie, family members and friends) play a vital role in the ongoing care and well-being of community-living older persons with Alzheimer disease and related dementia in combination with multiple chronic conditions. However, they often do so to the detriment of their own physical, mental, and emotional health. Caregivers often experience multiple challenges in their caregiving roles and responsibilities. Recent evidence suggests that Web-based interventions have the potential to support caregivers by decreasing caregiver stress and burden. However, we know little about how Web-based supports help caregivers. OBJECTIVE The objectives of this paper were to describe (1) how the use of a self-administered, psychosocial, supportive, Web-based Transition Toolkit, My Tools 4 Care (MT4C), designed by atmist, Edmonton, Alberta, Canada, helped caregivers of older adults with Alzheimer disease and related dementia and multiple chronic conditions; (2) which features of MT4C caregivers found most and least beneficial; and (3) what changes would they would recommend making to MT4C. METHODS This study was part of a larger multisite mixed-methods pragmatic randomized controlled trial. The qualitative portion of the study and the focus of this paper used a qualitative descriptive design. Data collectors conducted semistructured, open-ended, telephone interviews with study participants who were randomly allocated to use MT4C for 3 months. All interviews were audio-taped and ranged from 20 to 40 min. Interviews were conducted at 1 and 3 months following a baseline interview. Qualitative content analysis was used to analyze collected data. RESULTS Fifty-six caregivers from Alberta and Ontario, Canada, participated in either one or both of the follow-up interviews (89 interviews in total). Caregivers explained that using MT4C (1) encouraged reflection; (2) encouraged sharing of caregiving experiences; (3) provided a source of information and education; (4) provided affirmation; and for some participants (5) did not help. Caregivers also described features of MT4C that they found most and least beneficial and changes they would recommend making to MT4C. CONCLUSIONS Study results indicate that a self-administered psychosocial supportive Web-based resource helps caregivers of community-dwelling older adults with Alzheimer disease and related dementia and multiple chronic conditions with their complex caregiving roles and responsibilities. The use of MT4C also helped caregivers in identifying supports for caring, caring for self, and planning for future caregiving roles and responsibilities. Caregivers shared important recommendations for future development of Web-based supports.

Factors associated with oral chemotherapy adherence in specialty pharmacies.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19137-e19137
Author(s):  
Shanada Monestime ◽  
Ray D. Page ◽  
William M. Jordan ◽  
Subhash Aryal ◽  
Rafia Rasu
Keyword(s):  
Health Care Providers ◽  
Chronic Conditions ◽  
Care Patient ◽  
Oral Chemotherapy ◽  
Multiple Chronic Conditions ◽  
Care Providers ◽  
Factors Associated ◽  
Specialty Pharmacy ◽  
The Mean ◽  
The Impact

e19137 Background: Specialty pharmacies are expanding in the oncology setting and often favored by payors because of economic and operational benefits. However, challenges exist in coordination of care, patient safety, cost/reimbursement, and operational efficiency. While in-house specialty pharmacies mitigate these challenges due to close proximity of health care providers, these challenges can impact medication adherence. To date, limited data are available on adherence rates and factors associated with oral chemotherapy (OC) adherence in specialty pharmacy settings. Methods: Adult cancer patients who received their first OC between Aug.-Oct. 2018 were analyzed. Pharmacies were contacted to obtain OC pick-up dates over 6 months or until treatment completion. Patients were adherent if the proportion of days covered (PDC) was ≥90%. Descriptive and bivariate logistic regression models were performed to examine demographics, specialty pharmacy type (external vs. internal), distance from pharmacy to home, and chronic comorbidities. Results: Of the 80 patients analyzed, the mean age was 63.59 (SD ±11.8), 51.21% were female, 68.75% were white, 61.25% were married, 82.50% were smokers, 53.75% were on government insurance, 73.75% were using an internal pharmacy, and the mean distance traveled to pharmacy was 17.06 miles (SD±22.66). Thirty-five patients (43.75%) were adherent (mean PDC = 78%, range, 17-100%). Patients who went to an internal pharmacy were 1.81 times likely to be adherent than those who went to an external pharmacy [OR: 1.81, 95% CI (0.64- 5.11)]. We found that males were 1.21 times more likely to be adherent than females [OR: 1.21, 95% CI (0.50- 2.93)] and smokers were 2.21 times more likely to be adherent than non-smokers [OR: 2.21, 95% CI (0.63-7.78)]. Multiple chronic conditions were significantly associated with a decrease in OC adherence, even after controlling for covariates [OR: 0.66, 95% CI (0.66- 0.95); p = 0.02]. Conclusions: Patients with fewer comorbidities receiving OC from specialty pharmacies were significantly more adherent than those with multiple comorbidities. Further studies examining the impact financial toxicity has on adherence for patients with chronic conditions are warranted.

scholarly journals Typhoon eye effect versus ripple effect: the role of family size on mental health during the COVID-19 pandemic in Pakistan

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Tooba Lateef ◽  
Jiyao Chen ◽  
Muhammad Tahir ◽  
Teba Abdul Lateef ◽  
Bryan Z. Chen ◽  
...  
Keyword(s):  
Mental Health ◽  
Anxiety Disorders ◽  
Family Size ◽  
Health Care Providers ◽  
Vulnerable Groups ◽  
Ripple Effect ◽  
Health Issues ◽  
Care Providers ◽  
Populous Country

Abstract Background The recent outbreak of COVID-19 has impacted adversely upon the mental health of millions of people worldwide. Impacts on the mental health conditions and the associated predictors relating to adults in Pakistan, the fifth most populous country in the world, during the COVID-19 remain understudied. Our aim was to investigate distress, anxiety, and overall mental health and their associated predictors among Pakistani adults in this pandemic. We specifically examine mental health issues based on the distance from the epicenter, (a predictor that has revealed opposing evidence in other countries) based on the theories of typhoon eye effect and ripple effect. The sample consisted of 601 adults who were surveyed online about 2.5 months into the outbreak across Pakistan with varying distances from the epicenter of COVID-19 of Karachi. Results The results showed that 9.2 and 19.0% of the participants surpassed the cut-off criteria for distress and anxiety disorders, respectively. Overall, the distance from the epicenter positively predicted the mental health of adults in Pakistan, and family size negatively moderated this effect. The distance from the epicenter negatively predicted distress and anxiety disorders for adults in large families, which are quite common in Pakistan. Conclusion The evidence of the study interestingly finds that the prediction of the mental health of people by their distance from the epicenter depends on family size. The evidence of this study can help to provide initial indicators for mental health care providers to screen vulnerable groups in Pakistan, a populous country that continues struggling to cope with the COVID-19 pandemic.

Breastfeeding Experiences of Baccalaureate Nursing Students: A Qualitative Study

2020 ◽  
pp. 089033442097998
Author(s):  
Cheryl Langford ◽  
Marcella Gowan ◽  
Monica Haj
Keyword(s):  
Nursing Students ◽  
Health Care Providers ◽  
Baccalaureate Nursing ◽  
Community Support ◽  
Baccalaureate Nursing Students ◽  
Care Providers ◽  
Structured Interviews ◽  
Breastfeeding Support ◽  
Cross Sectional

Background Students returning to school who are breastfeeding face unique challenges. There is limited literature on breastfeeding university students. Several researchers have studied breastfeeding employees in the workplace. Institutions of higher education closely mimic the employment environment. Breastfeeding college students who express their milk while at school share similar challenges to employed mothers. A baccalaureate nursing program is rigorous and little is known about the challenges facing breastfeeding student nurses returning to classes. Research aim To explore the breastfeeding experience of baccalaureate nursing students. Methods Our study was a cross-sectional descriptive qualitative design. Purposive sampling was used to enroll participants ( N = 12). In depth, semi-structured interviews were conducted. Qualitative thematic analysis was used to analyze the data both manually and using Dedoose QDA software. Results An overarching theme of pervasive conflict between the role of the breastfeeding mother and the role of the student nurse surfaced. Three interrelated organizing themes also emerged; challenging, vulnerability, and resilience. Time constraints, self-care versus role demands, and structural accommodations contributed to the challenges. Only one participant indicated a knowledge of her breastfeeding rights. All of the participants expressed gratitude for faculty and community support, regardless of conflicts. Conclusion Breastfeeding participants were both vulnerable and resilient. Faculty may improve experiences through providing specific areas of support. A breastfeeding support policy outlining student rights and faculty responsibilities is needed to educate, guide, and enforce protections. Health care providers may enhance breastfeeding students’ experiences through anticipatory guidance, education, and continued support.

Commentary on “Diabetes and people with learning disabilities: issues for policy, practice and education”

2020 ◽  
Vol 25 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Brianne Redquest ◽  
Yona Lunsky
Keyword(s):  
Health Care ◽  
Learning Disabilities ◽  
Health Care Providers ◽  
Diabetes Care ◽  
Future Research ◽  
Care Providers ◽  
Family Carers ◽  
Content Type ◽  
Policy Practice

Purpose There has been an increase in research exploring the area of intellectual and developmental disabilities (IDD) and diabetes. Despite being described as instrumental to diabetes care for people with IDD, the role and experiences of family carers, such as parents and siblings, are often neglected in this research. However, it is clear that family carers do not feel that they have sufficient knowledge about diabetes. The purpose of this commentary is to extend the content from “Diabetes and people with learning disabilities: Issues for policy, practice, and education (Maine et al., 2020)” and discuss how family carers can feel better supported when caring for someone with IDD and diabetes. Design/methodology/approach This commentary discusses specific efforts such as STOP diabetes, DESMOND-ID and OK-diabetes for people with IDD including family carers. Encouragement is given for health care providers to recommend such programmes to people with IDD and their family carers. It is also suggested that health care providers involve family carers in diabetes care planning and implementation for people with IDD. Findings It is hoped that if changes are made to current diabetes practices and more research with family carers is conducted, diabetes prevention and management for people with IDD will be more successful and family carers can feel more confident in providing support to their loved ones. Originality/value Research exploring the role of family carers in diabetes care for people with IDD and diabetes is very limited. This commentary makes recommendations to help family carers feel better supported in their role. It also provides areas for future research.

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