Preparation for family care-giving: stroke as a paradigm case

• ? This article considers the nurse's role in assisting family (informal) carers who adopt their role suddenly, following an acute health crisis. Carers of stroke survivors are used as a ‘paradigm’ case to highlight the challenges faced by family members at the time of hospital discharge.
• ? The needs of family members who suddenly adopt a caring role are poorly understood, but greater awareness is needed as the Carers (Recognition and Services) Act (1995) provides statutory recognition of the rights of such individuals to an assessment of their needs, emphasizing the importance of carers making an informed choice based on a willingness and ability to adopt a care-giving role.
• ? Evidence suggests that new family carers are currently poorly prepared to take on their role, lacking the information and skills needed to provide good care. Nurses have a major role to play in preparing carers, but currently lack a systematic approach to assessment and intervention.
• ? Further empirical work is required to establish more clearly the needs of new carers and to develop and evaluate appropriate intervention strategies to address their needs.

     

Admission to care: facilitating role transition amongst family carers

• ? Admission to care after a period of family care-giving has been the focus of much recent research.
• ? Rather than being seen as an end in itself, admission is part of a process.
• ? This article concentrates on ‘reaching the end’ of family care-giving and the ‘new beginning’ of entering residential care.
• ? A cross-national study conducted in the USA and the UK is discussed, and similarities and differences in the two cultures are highlighted.
• ? Decisions to enter a nursing home were often taken hurriedly and with lack of information in both countries.
• ? Issues of quality of care and emotional responses by former carers were also important in both settings.

     

Partnership in care: parents' views of participation in their hospitalized child's care

• ? This paper describes parents' experiences of participation in their hospitalized child's care on a general surgical paediatric ward.
• ? The findings indicate that parents chose to participate because of concern for the child's emotional welfare. Influencing- factors included sense of parental duty, past experiences with hospitals, and concern for consistency of care.
• ? Parents' readiness to care was encouraged by a supportive family network, support from other parents, familiarity and experience with care.
• ? Parents were willing to adapt their parenting skills in order to be able to care for their child at home and were willing to perform more care provided it did not cause pain for the child, had the nurses' approval and increased their confidence and competence as carers.
• ? Lack of information, non-negotiation of roles, inadequate facilities, feelings of anxiety and loneliness were the difficulties parents experienced.

     

A study of nurses' views about the prevention of nosocomial urinary tract infections

• ? This study sought to discover the contribution of nursing practice to the prevention of hospital-acquired or nosocomial urinary tract infections (NUTIs), the most commonly occurring nosocomial infection.
• ? Seventy-five per cent of such infections are associated with urethral catheters.
• ? The practices of nurses who are caring for patients on a 24 h basis would appear to be fundamental to achieving any reduction in the incidence of NUTIs.
• ? This qualitative study utilized unstructured interviews to explore the views of 12 registered nurses about three key issues: first, what care do nurses give with the aim of preventing catheter-associated NUTIs; secondly, what improvements in practice would further prevent catheter-associated NUTIs; thirdly, what do nurses see as constraints to the prevention of catheter-associated NUTIs?
• ? The nurses identified many of the measures that were cited in the literature as effective for preventing NUTIs; however, in reality, they stated that their practice differed because of a lack of time to give care and to update themselves.
• ? The consequences of under-staffing were that junior and temporary staff (whose competence in preventing NUTIs was questioned) worked unsupervised.
• ? Those interviewed identified feelings of powerlessness in effecting preventative measures, and identified not only the role of medical staff in influencing NUTIs but also their inconsistent approach to care.
• ? All these forces effectively limited the nurses' ability to prevent NUTIs.
• ? The study is concluded with recommendations for changes in practice and further research.

     

The carer-led assessment process (CLASP): a framework for the assessment of need in dementia caregivers

• ? The initial and on-going assessment of individuals with dementia may not always fully reflect the expert knowledge of the caring situation that carers possess. In the absence of such knowledge a comprehensive and responsive assessment is unlikely to be achieved.
• ? This paper describes the development of a carer-led assessment process (CLASP) which it is suggested provides a flexible framework for the assessment of need in carers of dementia sufferers.

     

The challenges of improving discharge planning in Sweden and the UK: different but the same

• ? Discharge of older people from hospital has been an area of concern for over 20 years.
• ? The present emphasis on rapid throughput of patients in acute care settings is likely to exacerbate existing problems.
• ? Improving current practice will mean addressing a number of complex issues to do with communication between agencies and professions.
• ? Despite different welfare systems, many of the challenges of discharge planning are shared in different countries.
• ? This paper describes attempts to involve patients and carers in discharge planning in Sweden and the UK and identifies a number of areas which require attention if the ideals of patient and carer empowerment are to be achieved.

     

Staff perspectives on the role of the nurse in rehabilitation wards for elderly people

• ? The increasing demand for cost-effective and efficient health care may create a demand for more demonstrably effective hospital-based rehabilitation services, with the explicit goal of enabling patients to return home after short admissions; thus rehabilitation is centre stage.
• ? This paper reports the findings from a study of the rehabilitation of elderly people in hospital; in particular it focuses on an aspect of the process of care: namely staff perceptions of rehabilitation work, with particular emphasis on the role of the nurse.
• ? A conversational style of interviewing was used with 56 staff respondents from two rehabilitation wards for elderly people.
• ? Findings suggest that therapists are often seen as experts, and nursing is viewed as separate from rehabilitation, and hence nurses are an under-utilized resource in this field.
• ? It is suggested that there is a need to examine further the reality of multidisciplinary teamwork in rehabilitation, particularly with respect to maximizing the potential contribution of nurses, with the end goal of improving patient outcomes.

     

Spirituality and nursing practice

Summary

• ? Spirituality is often equated or used synonymously with the word religion but it appears this concept can be defined in broader terms.
• ? Nurses do not appear to consider spirituality adequately in clinical practice but if holistic care is to be given to patients it is essential that the spiritual component of individuals is addressed.
• ? This paper explores the concepts of spirituality and clinical practice. Clarification of the term spirituality is given followed by a critical review of the literature in order to establish its relevance to nursing practice and to what extent patients' spiritual needs are met. Aspects of spiritual assessment and spiritual care are also outlined.
• ? It is suggested that nurse education may help nurses incorporate spirituality into clinical practice by increasing their knowledge and understanding of such a concept.

     

A hermeneutic analysis of the lived experiences of associate nurses

• ? In order to understand better the role of associate nurse in the primary nursing model, narratives from associate nurses were analysed using hermeneutic approach.
• ? Major themes in the narratives included: connecting with patients, collaborating with other nurses, and making decisions.
• ? Associate nurses were found to define their practice as ‘primary’ in terms of their contributions to patient care and being a responsible professional.
• ? A better understanding of the associate role in clinical practice can enhance patient care and professional relationships.
• ? Further research into the philosophical nature of primary nursing is suggested.

     

Younger-onset Alzheimer's disease: learning from the experience of one spouse carer

• ? There are estimated to be 17 000 younger sufferers of dementia currently living in the UK. At present, individualized service and practice initiatives for younger sufferers and their carers remain fragmented and poorly developed. This is despite potential additional caregiving stressors caused by the age of onset, such as financial difficulties due to disruption in the work pattern, children still living at home, and the sufferer's decreased life expectancy.
• ? Drawing on an individual carer's personal case history, this article details a spouse carer's individual experience of her husband's decline through the stages of younger-onset Alzheimer's disease. Pointers for policy and practice for younger sufferers and their carers are drawn from this case history and a role for the community psychiatric nurse is outlined.

     

Evaluation of a new night nursing service for elderly people suffering from dementia

• ? A new night hospital nursing service was developed for older people with dementia.
• ? A case study approach to evaluation was adopted using a structure-process-outcome quality assurance cycle.
• ? The effects and attendance of patients are reported and discussed.
• ? Discussion relating to care provision for the future is presented.
• ? The effects on carers of patients' attendance are briefly discussed.

     

The organization of care: its influence on health education practice on acute wards

Summary

• ? This paper explores the relationship between organization of care and nurses' health education practice at ward level and is based on data from a larger 2-year Department of Health-funded study examining the health education and health promotion role of the nurse in acute-ward settings.
• ? Concepts such as continuity of care, autonomy, accountability and responsibility are examined in terms of their association with organization of care and primary nursing in particular.
• ? Other factors closely associated with organization of care such as ward democracy and the empowerment of nurses, are also discussed in relation to ward-based health education practice.
• ? Data analysis reveals that the way in which care is organized on the ward may have a direct influence on the type, quality and consistency of health education advice given to patients.

     

Cognitive therapy as a tool for caring for the elderly confused person

• ? With the increase in the numbers of elderly people, methods to improve the quality of life for this population has never been more relevant. As the primary carers for this group of people, nurses are likely to be faced with this task.
• ? Cognitive therapies such as reality orientation, validation, reminiscence and life review, can help to maintain or improve aspects of cognitive or behavioural functioning for the elderly confused.
• ? If this in turn can increase life satisfaction for those elderly suffering from dementia then cognitive therapies must be addressed as means to improve individual quality of life.
• ? Existing research otters contradictory evidence as to the practical application and usefulness of such therapies. More substantial research must be undertaken in the area, addressing nursing perspectives with regards to the implementation of cognitive therapies.
• ? The author maintains that the cognitive therapies discussed in this paper have great potential for use within care of the elderly and despite controversial research results, can help to maintain or improve the quality of life for the elderly confused.

     

The evolution of the RSCN

• ? The first English Child Branch students will complete their programme of training in September of this year. It is timely, therefore, to review again the role that has emerged for nurses interested in the care of children.
• ? The status of children's nursing has in the past been uncertain, and their role poorly understood. The evolution of high-quality care in an increasingly complex field is explored and some issues which remain, are discussed.
• ? As the care of children becomes more specialized the need to ensure a cohesiveness exists is essential in order to move practice forward in a logical and comprehensive fashion. The field is too small to survive fragmentation and it is not in the best interest of the child and its family.
• ? Throughout the paper the child is the focal point which, together with the need to enable families to knowledgeably participate in their own child's care, has been the major thrust behind recent changes.
• ? The paper explores not just the past and present, but some of the issues that need to be considered in the future.

     

What can be the relevance of the psychiatric nurse to the life of a person who is mentally ill?

• ? Mental illness is popularly conceived as a disorder located in the individual. This is a misconception. An alternative view is proposed, based around the writings of Smail and referring to Laing's work and the author's professional and personal experience.
• ? The concepts and techniques of psychiatry and associated disciplines pathologize individuals. The theme that they therefore do more harm than good is developed.
• ? In place of these techniques we should implement the process of ‘taking care’ described by Smail. This process is explained as demystification and comfort, and some of its benefits and difficulties are examined in relation to clinical practice.
• ? Finally, the role of the psychiatric nurse in clinical work with individuals and issues of professional identity are considered. The merits of a reformulation of our role and identity in line with the preceding analysis are emphasized.

     

The need for support services for family carers of people with motor neurone disease (MND): views of current and former family caregivers a qualitative study

Purpose: Family carers provide the majority of home-based care for people with motor neurone disease (MND). Carers’ need for, and use of, support services are not fully understood; this study aimed to explore, from a qualitative perspective, the views of current and former family carers of people with MND. Methods: A qualitative study was undertaken in Northwest England, using narrative interviews with current (18) and former (10) carers of a family member with MND. An optional longitudinal element involving diary completion was offered to the current carers. Data were analyzed using a thematic framework approach. Results: Carer’s needs vary, but encompass the provision of information and training, availability of respite care, counselling, and access to trained paid-for carers. Conclusions: There is need for a range of support services to be made available from which carers can select those most appropriate for them. Some support services are not always available for carers of this client group. There is a need for carers to access greater manual handling and training for physical care. Without sufficient support, carer burden can be overwhelming which may impact on the place of care of the patient and ultimately has implications for health and social care services.

Implications for Rehabilitation

• People with motor neurone disease have complex care needs with family carers providing the majority of home-based care.

• This study has shown there is a need for increased training in manual handling and physical care for family carers.

• Failure to properly support family carers increases the burden on them and if left unchecked may ultimately affect where the patient is cared for.

• A range of support services are needed for family carers with clear signposting for them to select those most appropriate for their individual needs.

     

Powerlessness of caregivers in home care

• ? Patients are not the only ones who suffer when they have a chronic illness; significant others and family members can also suffer.
• ? Reaction to chronically ill family members and the problems in their care varies among significant others.
• ? As the number of elderly individuals is increasing the number of chronically ill people needing care is also increasing.
• ? Not only do patients feel powerless but personal factors, factors in the environment, and factors related to the illness itself can also provide a conceptual framework for organizing factors that affect feelings of powerlessness among family members and significant others.

     

The USA's nurse managers and UK's ward sisters: critical roles for empowerment

• ? The nurse manager/ward sister^* role is becoming endangered as many of these nurses are being asked to take fiscal and personnel responsibility for multiple units/programmes and supervise more non-registered nursing staff.
• ? Loss of this important nurse manager/ward sister role could severely decrease nursing's voice in the development and implementation of policies that affect nurses arid the care they deliver.
• ? The authors review 20 years of literature from both the USA and the UK regarding supportive supervision and the role of the nurse manager/ward sister. Nurse managers/ward sisters were found to be key individuals within the entire health-care organization.
• ? Nurse managers/ward sisters can empower the nurses they surpervise to initiate changes that will improve patient care. Nurse managers/ward sisters can also improve the working conditions and thus increase the job satisfaction and retention of those they supervise.
• ? Strategies for being more supportive of these overworked and endangered nurse managers/ward sisters are suggested.

     

Student midwives' learning experience on the wards

• ? This paper is based on an investigation into the learning experiences of student midwives in the clinical setting in one maternity unit in the Republic of Ireland.
• ? A questionnaire approach was adopted for the data collection and 42 student midwives participated in the study.
• ? A number of factors were identified which appear to influence students' experiences of ‘learning on the job’. The quality of their clinical teaching and their observations of the way in which trained staff practise midwifery may influence their decision to continue practising midwifery following registration.
• ? These findings clearly point to the importance for midwives to reassert their true role as ‘independent practitioners’ of normal maternity care.

     

“Stuck in a loop of fear”: a phenomenological exploration of carers’ experiences supporting a spouse with acquired brain injury

Abstract

Purpose: Family caregivers are important to facilitating the rehabilitation of individuals with brain injury. However, research shows spousal carers often reporting poorer health and well-being with psychosocial challenges including increased marital dissatisfaction. This study explores the accounts of participants caring for a spouse with brain injury.

Materials and methods: This study used semi-structured interviewing and interpretative phenomenological analysis.

Results: One theme, “Living in and beyond the loop of fear”, with two subheadings is reported. Participants’ attempts to manage their fears prominently defined their early caregiving. Fears were aggravated by the vulnerability of their spouse’s health which partially owed to brain injury sometimes having no symptoms prior to its onset. Consequently, participants anxiously strove to prevent further harm to their spouse’s health due to what they perceived as the continued “hidden” threat of brain injury. Therefore, participants became hypervigilant, leaving themselves vulnerable to burnout. Over time, some participants modified care practices and managed fears using beliefs accepting their limits to protect their spouses’ health.

Conclusions: Findings suggest that beliefs conducive to acceptance helped carers to develop more sustainable, less over-protective, care. Interventions to help carers develop similar beliefs could be provided in therapeutic settings. Recommendations for future research are made.

• Implications for Rehabilitation

• Caring for a long-term partner with acquired brain injury has considerable challenges which can threaten an individual’s health and well-being.

• Our research reports on carers’ experiences of anxiety which they managed through hypervigilant and overprotective practices which put them at risk of burnout.

• Consequently, we recommend the promotion of care beliefs that reframe caregiving: recognising the carer’s limitations to safeguard a spouse, whilst accepting the vulnerability of the spouse’s health. We propose that promoting such principles in therapeutic settings may better equip carers emotionally to provide sustainable care, something which could benefit the carer and spouse’s rehabilitation alike.