• Quality of life of Korean family caregivers with older stroke patients: Using the stress and coping model

      Lee, JuHee; Picot, Sandra J. (2005)
      The study was designed to examine the proposed antecedents and mediators of QOL of family caregivers for older stroke patients in Korea using the stress and coping model (Lazarus & Folkman, 1984). This study identified relationships between antecedent variables (caregiver, stroke patient, and environmental variables) and the caregiver QOL. Additionally, this study examined potential moderating effect of obligation, the cultural characteristic, as well as the mediating effect of perceived social support and caregiver appraisal. Using the general linear model, the caregiver QOL differences by caregiving duration were examined. A cross-sectional design was employed to examine factors that influenced QOL of Korean family caregivers of older stroke patients. The stress and coping model (Lazarus & Folkman, 1984) guided the study. Data were collected from participants at an outpatient clinic of a stroke center at three hospitals and two home health agencies located in Seoul, the capital city of Korea and its suburban area of Kyunggi-do. The questionnaire was self-administered. The Statistical Package Social Sciences (SPSS) 13.0 was used for data analyses. A total of 147 caregivers participated in this study. The mean age of caregivers for this study was 50 (SD = 14.15). Most of caregivers were female (77.6%), married (78.2%), educated greater than high school (80.9%), and unemployed (71.4%). Sixty-four caregivers (43.5%) were spouses of older stroke patients, while 81 subjects (55%) were adult children (i.e., daughter, daughter-in-law, and son). The hypothesis test revealed that 13 predictors explained 23% of the variability in caregiver QOL. Especially, weekly caregiving hour and caregiver gender were found to be significant predictors of caregiver QOL. Furthermore, perceived social support was a mediator between the antecedent variables and QOL. However, caregiver appraisal did not mediate the relationship of antecedent variables and QOL. Although there was a weak relationship between the caregiver appraisal and the caregiver QOL, the cultural characteristic--obligation level moderated the relationship between caregiver appraisal and QOL. Only in situations of high obligation, the effect of stress appraisal on QOL was buttressed in spouse caregivers. There was a difference between short-term and long-term caregivers in their QOL. Those caregivers who cared for stroke patients more than 13 months reported better QOL than those caregivers who took care of patients ≤12 months. The study results contributed to the understanding of caregiving process and the importance of examining of both mediators and moderators of the process among Korean family caregivers. The knowledge gained from this study will be used to develop culture-specific and timely caregiver interventions and social policies to directly support the Korean family caregivers and indirectly stroke patients.
    • The relationship between the rewards, costs, and coping strategies of black family caregivers

      Picot, Sandra J.; Baldwin, Beverly Ann, 1941-; Rasin, Joyce (1991)
      This study was designed to describe the relationship between perceived rewards, costs, and coping strategies of black family caregivers who provided care to an elderly demented relative. Selection of coping strategies is predicated on a continuous transaction between the caregiver's appraisal of what is at stake for the caregiver in the caregiving situation and her personal resources (Folkman & Lazarus, 1980). However, research studies have suggested the caregiver's ethnicity, household income, relationship to the carereceiver, carereceiver's geographic area of residence, and the caregiving demands may serve as confounding variables. Most caregiver studies have either used predominantly white samples or treated black subjects as a homogeneous group. Therefore, the relationship of rewards, costs, and coping strategy selection with controls for the above confounding variables in an all black sample has not been done. Face-to-face interviews of 83 black female caregivers of elderly demented relatives were conducted. Coping was measured by the Jalowiec Coping Scale, rewards from the Picot Caregiver Rewards Scale, and costs from the Cost of Care Index. The demographics form included caregiver-carereceiver relationship, caregiver household income, and carereceiver geographic area of residence. The Modified Wood's Social Support Questionnaire measured the perceived quality of social support; and the Texas Research Institute of Mental Sciences Behavioral Problem Checklist evaluated caregiving demands. The seven major predictors (together) accounted for a significant amount of the overall variance in selected coping strategies, palliative emotive, confrontive active, positive thinking, problem analysis, and social support use coping. When the influences of all of the variables were removed except rewards and costs, the overall variance in palliative emotive coping, positive thinking, and problem analysis was significantly explained by rewards and costs. Caregiving demands and perceived quality of social support emerged as major predictors of total coping and social support use. Caregiver household income was a major predictor of both confrontive active and palliative emotive coping. Costs, also, predicted palliative emotive coping. Rewards were the most influential predictors of both positive thinking and problem analysis. Neither caregiver-carereceiver relationship nor carereceiver geographic area of residence emerged as significant predictors of either total coping score or individual coping strategies.
    • Using a Clinical Indicators Checklist to Determine Family Meeting Needs

      Heng, Christina L.; Alessandrini, Erica (2020-05)
      Problem & Purpose: Patients admitted to the surgical intensive care unit (SICU) are critically ill and may be unable to participate in their care, passing the burden of decision-making onto their family. Family members often express dissatisfaction with the healthcare team communication, making it difficult for them to make informed decisions about their loved ones. Studies have shown implementing family meetings within 72 hours of ICU admission improves communication between family members and the healthcare team. This quality improvement project aimed to improve family satisfaction with the healthcare team communication by implementing interdisciplinary family meetings within 72 hours of SICU admission for families of patients who meet specific clinical indicators. Methods: A checklist was developed based on the literature and input from the nurse educator, nurse manager, and medical director, to recognize specific clinical indicators with which a patient presents that likely require proactive communication from the healthcare team. The presence of at least one indicator prompted a response in which the dayshift nurse notified the unit social worker and SICU provider to initiate a family meeting within 72 hours of ICU admission. To determine a family member’s level of satisfaction with the healthcare team communication, the SICU family liaison distributed the Family Satisfaction With Intensive Care Unit 24R (FS-ICU 24R) questionnaire after the patient was discharged from the SICU. Results: There was a statistically significant increase in the completion of the clinical indicators checklists, X2 (1, n=964) = 75.96, p < 0.001. The number of family meetings did not increase significantly from pre- to post-implementation. The Fisher exact test statistic value was .52. The result was not significant at p < .05. Fifteen families were updated at the bedside (46.9%). Questionnaires returned resulted in satisfaction scores of greater than 75%. Conclusion: Using the clinical indicators checklist may have increased staff awareness for family meeting needs. However, conclusions could not be drawn from the relationship between family satisfaction and attendance at formal family meetings. Other methods of communication such as updates at the bedside and daily rounds may provide sufficient communication for families of patients who meet minimal clinical indicators.