Healthcare interventions for older people with dementia and family caregivers in Europe: A scoping review.

AIM: This study aimed to examine the extent, range and variety of research in Europe describing healthcare interventions for older people with dementia (PwD) and family caregivers. METHODS: This was a scoping review and followed the PRISMA Scoping Review guideline. MEDLINE, CINAHL and Cochrane library databases were searched for studies published between 2010 and 2020. Studies reporting healthcare interventions in Europe for PwD over 65 years and their family caregivers were included. RESULTS: Twenty-one studies from six European countries were included. The types of healthcare intervention identified were categorized as follows: (1) family unit intervention (interventions for both PwD and their family caregiver), (2) individual intervention (separate interventions for PwD or family caregivers) and (3) family caregiver only intervention (interventions for family caregivers only but with outcomes for both PwD and family caregivers). CONCLUSIONS: This review provides insight into healthcare interventions for older PwD and family caregivers in Europe. More studies are needed that focus on the family as a unit of care in dementia.

Implementation and efficacy of knowledge translation frameworks in family focused nursing care: A scoping review.

AIM: To provide an overview of the characteristics, variety and outcomes of knowledge translation (KT) strategies used in nursing care involving adult patients and their family members. BACKGROUND: The gap in providing family nursing practice could be due to a lack of explicit KT frameworks and understanding of ways to translate evidence-based knowledge into clinical practice. DESIGN: A scoping review conducted according to the Joanna Briggs Institute. METHODS: The review is reported according to PRISMA-ScR. Relevant studies were searched in MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL Complete, ProQuest Nursing & Allied Health Premium, PsycINFO, Social Work Abstracts, Social Services Abstracts and Scopus. Grey literature was searched in ProQuest Dissertations & Theses Global. Search results were imported into the web-based programme Covidence. Studies describing concepts of KT, strategies of implementation, involvement of families and nurses/family caregivers in adult health care and conducted within the last 15 years were included. RESULTS: Eight studies met the inclusion criteria. Three studies used the KTA Framework to guide the implementation process. The remaining five studies used different frameworks/guidelines to translate a variety of family focused interventions into their clinical practice. Translation strategies were often targeted towards nurse education. Reported outcomes included nurses' attitudes towards and acceptance of involving families in health care. The outcomes were conceptualized and measured differently, showing inconclusive results on effectiveness on family focused care and family health. CONCLUSION AND IMPLICATIONS FOR CLINICAL PRACTICE: The application of KT frameworks to implement evidence-based family nursing into clinical practice is limited. The process of KT mainly targets at nurses' adoption of family focused interventions with limited information about short-, intermediate- and long-term efficacy on family health. Clinical leaders should consider time and resources needed to implement family focused care KT strategies before putting it into practice. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. Data were obtained from other's literature.

Nurses' attitudes towards family importance in nursing care across Europe.

AIMS AND OBJECTIVE: To explore differences in nurses' attitudes regarding the importance of family in nursing care and factors associated with nurses' attitudes across 11 European countries. BACKGROUND: Family involvement in healthcare has received attention in many European healthcare systems. Nurses have a unique opportunity to promote family involvement in healthcare; however, their attitudes and beliefs may facilitate or impede this practice. DESIGN: A cross-sectional survey across European countries. METHOD: A broad convenience sample of 8112 nurses across 11 European countries was recruited from October 2017 to December 2019. Data were collected using the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire. We used the STROBE checklist to report the results. RESULTS: There were significant differences in nurses' attitudes about families' importance in nursing care across Europe. Country was the factor with the strongest association with the total scores of the FINC-NA. Older age, higher level of education, increased years since graduation, having a strategy for the care of families in the workplace, and having experience of illness within one's own family were associated with a higher total FINC-NA score. Being male and working in a hospital or other clinical settings were associated with a lower total FINC-NA score. CONCLUSION: Nurses' attitudes regarding the importance of family in nursing care vary across 11 European countries. This study highlights multiple factors associated with nurses' attitudes. Further research is necessary to gain a deeper understanding of the reasons for nurses' different attitudes and to develop a strong theoretical framework across Europe to support family involvement in patient care. The inclusion of family healthcare programs in the baccalaureate curriculum may improve nurses' attitudes. RELEVANCE FOR CLINICAL PRACTICE: In clinical practice, the focus should be on identifying influencing factors on nurses' attitudes to enhance families' importance in nursing care across Europe.

Healthcare practices and interventions in Europe towards families of older patients with cardiovascular disease: A scoping review.

BACKGROUND: In Europe, cardiovascular disease is one of the predominant causes of mortality and morbidity among older people over 65 years. The occurrence of cardiovascular disease can have a negative impact on the quality of life of older patients and their families and family health overall. Assuming that illness is a family affair shaped by culture and health care systems, we explored European health care practices and interventions toward families of older patients with cardiovascular disease and heart failure. AIMS: This paper aimed to determine the extent, range, and variety of practices and interventions in Europe directed to families of older patients and to identify knowledge gaps. MATERIALS & METHODS: A scoping review was conducted including studies published in Medline, CINHAL, or Cochrane library between 2009 and mid-2020. RESULTS: A total of 22 articles from 17 studies were included, showing diverse practices and interventions. The interventions targeted the family as a unit (six studies), dyads (five studies), patients alone, but assessed family members' reactions (five studies) or the family member primarily, but assessed the reaction of the patient (one study). Target outcomes were family caregiver burden; health-related QoL; and perceived control in patients; and family functioning and changes in health behavior or knowledge in both, family members and patients. Most studies did not include an integral view of the family as the unit of care but rather had a disease-centered approach. DISCUSSION: This scoping review provides insight into a variety of healthcare practices towards families of older patients with cardiovascular disease in Europe. Clarifying underlying assumptions to involve families is needed. More studies with family-focused approaches as integral models could lead to practices that improve families' well-being. Exploring integral models for their acceptance in health care and family systems appears pertinent to develop European policy to support and add to family health.

The family transition experience when living with childhood neuromuscular disease: A grounded theory study.

AIMS: Neuromuscular diseases are rare conditions that present with progressive muscular weakness. As affected children transition into adulthood, they become more physically dependent on their families for support. There is little evidence on the family transition experience, which this study explored to identify experiences, challenges, and strategies of coping. DESIGN: Informed by family systems theory, a constructivist grounded theory study was conducted (2014-2017). METHODS: Data were collected by one-on-one interviews with a purposive sample of affected Swiss individuals and their families from 2015 to 2016. Data analysis used coding, memo writing, theoretical sampling, and constant comparison techniques. RESULTS: The analysis of 31 interviews with 10 affected individuals and 21 family members resulted in an interpretive theory constituted of four categories: (a) living with physical dependence, while striving for independence; (b) balancing proximity; (c) conforming and challenging social standards and expectations; and (d) grieving for loss, while joining forces for life. CONCLUSION: Family functioning and well-being were threatened by recurring tension from stress, physical and emotional difficulties, strained relationships, and conflict. The families' strategies of coping and adaptation and their relationships and communication shaped their transition experience. IMPACT: Families that experience threats to their well-being and functioning would benefit from: needs assessment and monitoring; planning of appropriate family interventions; support of family relationships and communication, effective coping, and mastery; and positive adaptation to change.

Effect of family nursing therapeutic conversations on patients with heart failure and their family members: Secondary outcomes of a randomised multicentre trial.

AIMS AND OBJECTIVES: This study evaluates the short-term (3 months), medium-term (6 months) and long-term (12 months) effect of family nursing therapeutic conversations added to conventional care versus conventional care on social support, family health and family functioning in outpatients with heart failure and their family members. BACKGROUND: It has been emphasised that increased social support from nurses is an important resource to strengthen family health and family functioning and thus improve the psychological well-being of patients with heart failure and their close family members. DESIGN: A randomised multicentre trial. METHODS: A randomised multicentre trial adhering to the CONSORT checklist was performed in three Danish heart failure clinics. Consecutive patients (n = 468) with family members (n = 322) were randomly assigned to either the intervention or control group. Participants were asked to fill out family functioning, family health and social support questionnaires. Data were measured ahead of first consultation and again after 3, 6 and 12 months. RESULTS: Social support scores increased statistically significant both at short-term (p = 0.002) medium-term (p = 0.008) and long-term (p = 0.018) among patients and their family members (p = <0.001; 0.007 and 0.014 respectively) in the intervention group in comparison with the control group. Both patients and their family members reported increased reinforcement, feedback, decision-making capability and collaboration with the nurse. No significant differences between the intervention and control groups were seen in the family health and family functioning scales among patients and family members. CONCLUSIONS: Family nursing therapeutic conversations were superior to conventional care in providing social support from nurses. RELEVANCE TO CLINICAL PRACTICE: Family nursing therapeutic conversations are suitable to improve the support from nurses among families living with heart failure.

Health practices in Europe towards families of older patients with cancer: a scoping review.

INTRODUCTION: In Europe, cancer is one of the predominant causes of mortality and morbidity among older people aged over 65. A diagnosis of cancer can imply a negative impact on the quality of life of the older patients and their families. Despite research examining the impact of cancer on the family, it is unclear what kind of information is available about the types of clinical practice towards older patients with cancer and their families. The aim is to determine the extent, range and variety of research in Europe describing health practices towards families of older patients with cancer and to identify any existing gaps in knowledge. METHODS: Scoping review. RESULTS: A total of 12 articles were included, showing that family interventions are generally based on end-of-life care. Most studies used a qualitative approach and involved different types of family member as participants. Most studies were conducted in the UK. CONCLUSIONS: Review findings revealed limited knowledge about health practices in Europe towards families with an older patient with cancer. This review indicates a need to increase family-focused research that examines health practices that meet the needs of families of older patients with cancer. Seeing cancer as a chronic disease, there is an urgent need for the implementation of family-focused interventions.

Psychometric evaluation of the German version of a social support scale of FAFHES (Family Functioning, Family Health and Social Support).

BACKGROUND: Family members often need to be supported in informal care of the elderly and desire to be involved into care planning and decision-making. Valid and reliable instruments are needed to measure how family members perceive the care and support they receive from nurses for older family members living at home. AIM: The purpose of this study was to translate the 20-item social support scale of the Family Functioning, Family Health and Social Support (FAFHES) questionnaire from English to German and test the validity and reliability of the scale among Swiss-German-speaking family caregivers of home-dwelling elderly people who receive home healthcare services. METHODS: A cross-sectional study was conducted to test the empirical and psychometric properties of the translated and culturally adapted version of the social support questionnaire. A factor analysis with the principal component analysis PCA was used to test construct validity. The internal consistency of items was measured with the Cronbach`s alpha coefficient. RESULTS: After a rigorous translation process the original 20-item questionnaire was adapted into a 19-item version and tested with family caregivers (n = 207) of home-dwelling elderly. Psychometric testing of the German version of the social support questionnaire revealed that the three factors - affirmation, affect and concrete aid - were congruent with the original questionnaire. The accounted variance was 79.5% and the internal consistency determined by the Cronbach's alpha was 0.973. CONCLUSION: The German version of the social support scale of the FAFHES questionnaire is a valid and reliable instrument to assess family perceived support on three dimensions - affirmation, affect and concrete aid - received from nursing professionals. The questionnaire should be tested further in other German-speaking populations.

[Preparedness to provide care in relation to the satisfaction with hospital discharge planning and level of knowledge of relatives to elderly patients]. / Die Zufriedenheit mit der Austrittsplanung und die Informiertheit von Angehörigen beeinflussen die Bereitschaft, Pflege zu übernehmen.

Preparedness to provide care in relation to the satisfaction with hospital discharge planning and level of knowledge of relatives to elderly patients Abstract. BACKGROUND: Relatives are a great resource for older people who are discharged after hospitalization. Studies have so far shown very little about the readiness of relatives to aid in caregiving. AIM: The study examined if relatives showed a relationship between readiness to provide care and satisfaction with hospital discharge management as well as group differences between well-informed and less informed relatives. METHOD: In addition to demographic data, the preparedness to provide care, satisfaction and extent of knowledge of relatives were surveyed using a retrospective cross-sectional study. Analyses were made of the relationship between preparedness to provide care and satisfaction with hospital discharge management, as well as group differences between informed and less informed relatives in terms of their preparedness to provide care. RESULTS: Of the 111 relatives, the majority were adult offspring (55.9 %) and partners (32.4 %) that participated in the study. A weak correlation was detected between the satisfaction with the hospital discharge planning of relatives and their willingness to provide care (rs = -0.113, p = 0.267). The group differences between well-informed and less informed relatives were significant (t(102) = 2.301, p = 0.023). CONCLUSION: Relatives that evaluated themselves as well informed are more likely to be in the position to provide informal care. Therefore, it is necessary to involve relatives more in the planning of hospital discharges and to inform them better. Experimental studies are necessary to find out if the preparedness to provide care can be increased through good discharge planning and specific information provision.

A world shared - a world apart: the experience of families after the death of a significant other late in life.

AIMS: The aim of this study was to investigate the impact of the death of an older member on families. BACKGROUND: The death of a significant other in later life is a dramatic moment. Research has demonstrated that some older persons face negative consequences for their well-being. A majority, however, exhibit resilience in the wake of loss. Nonetheless, the relational process through which older persons come to terms with the loss in interaction with their families is little understood, but vital to support bereaved families. DESIGN: Heideggerian hermeneutic phenomenology. METHODS: A purposive sample of ten older persons with their families, represented by children, grandchildren and in-laws (n = 30) were interviewed several times in 2013, alone (n = 16) and in family groups (n = 21), 6-23 months after their significant other's death (mean age 81 years). Data collection and thematic analysis was informed by van Manen's and Benner's analytical strategies. FINDINGS: Three family themes were discerned. First, through meaning-making, bereaved families weaved the death into their family narrative. Second, through sharing-not sharing their feelings and daily moments, family members lived with the loss both together and alone. Third, some families faced upheaval in their family life, which required them to re-create their everyday life, whereas other families continued with little change. CONCLUSIONS: Findings demonstrate that families hold an inherent capacity to make meaning of the death and enact family thereafter. Family relations arose as interplay of different, contradicting forces. Nurses should facilitate families' meaning-making of the death, attend to their converging and diverging sense of loss and strengthen family caring.

Validity and reliability of the Danish version of the 9-item European Heart Failure Self-care Behavior Scale.

OBJECTIVE: To assess the self-care of patients with heart failure (HF), reliable and validated instruments are needed. The aim of this study was to test the validity and reliability of the Danish version of the European Heart Failure Self-care Behavior Scale (EHFScBS-9) based on previous studies reporting 1, 2 and 3 factors, respectively. METHODS: A convenience sample of 147 patients with HF completed the EHFScBS-9. Psychometric properties of the Danish version of the EHFScBS-9 were tested with factor loadings, factor correlations and goodness-of-fit indices for four different measurement models based on confirmatory factor analysis. RESULTS: All of the items, except item 9 about regular exercise, demonstrated satisfactory item-total correlation ≥0.30. Regarding the fit of the models on the sample data, the most superior fit was observed for the two-factor solution in terms of root-mean-square error of approximation (RMSEA), goodness-of-fit index (GFI), adjusted GFI (AGFI) and comparative fit index (CFI), which all reached the predefined threshold value, except for the normed fit index (NFI) at 0.90. Factor score determinacy (FSD) for the four models tested was 0.88 for the one-factor solution, 0.54 and 0.87 for the two-factor model, 0.83-0.55 for the first three-factor model and 0.87-0.38 for the second three-factor model. CONCLUSIONS: The EHFScBS-9 questionnaire is a valid and reliable instrument to assess heart failure-specific self-care behaviours in a Danish population.

Patient Characteristics Associated With a Successful Response to Nurse-Led Care Programs Targeting the Oldest-Old: A Comparison of Two RCTs.

BACKGROUND: To improve the effectiveness of community-based care programs, especially those targeting the oldest-old population (80+), data are needed that elucidate those factors associated with a successful response to the intervention. Two comparable nurse-led care programs have been evaluated in two large randomized controlled trials (RCTs), one in Switzerland and one in the Netherlands. AIMS: To identify common patient characteristics that are related to a successful response to proactive nurse-led care, we explored if and to what extent, identical factors were present in both study populations. METHODS: A secondary data analysis using trial data from the intervention group of both RCTs was conducted. The study sample consisted 461 older adults, 230 from the U-PROFIT trial (the Netherlands) and 231 from the HPC trial (Switzerland). The mean age of the total sample was 85.1 years (SD 3.7). The UPROFIT intervention, delivered by registered nurses, included a frailty assessment and a comprehensive geriatric assessment (CGA) at home followed by an individualized evidence-based care plan, care coordination, and follow-up. The HCP intervention was delivered by advanced practice nurses consisting of four home visits and three phone calls, and was guided by the principles of health promotion, empowerment, partnership, and family-centeredness. A successful response was defined as "stable" or "no decline" in daily functioning at follow-up. Daily functioning was measured with 13 items of activities of daily living and instrumental activities of daily living. Multivariate logistic regression models were applied to calculate the association between individual characteristics and a successful response. RESULTS: Almost half of the participants in the U-PROFIT trial (50.9%), and two-thirds (65.7%) of the participants in the HCP trial had a successful response at follow-up. Fewer comorbidities and a better self-rated health had the strongest predictive value for benefiting from the intervention (OR = 0.83 [95% CI 0.66-1.03], and OR = 1.5 [95% CI 0.92-2.45]), respectively. LINKING EVIDENCE TO ACTION: Two large RCTs demonstrated that a preventive nurse-led care program can preserve daily functioning in the oldest-old population. Older people with few comorbidities and higher self-rated health had a higher likelihood of a positive outcome. Unraveling the characteristics associated with a successful response provides important information for further refining and targeting an intervention to obtain maximum effectiveness. More effort is needed to modify interventions for the oldest-old with multiple morbidities and low levels of education.

Being an informal caregiver for a relative with liver cirrhosis and overt hepatic encephalopathy: a phenomenological study.

AIMS AND OBJECTIVES: To explore the experiences of being an informal caregiver for a relative with liver cirrhosis and overt hepatic encephalopathy. BACKGROUND: Overt hepatic encephalopathy is a common complication in patients with liver cirrhosis. It is associated with decreased quality of life for patients, and presents a major burden for caregivers. The involvement of informal caregivers in medical care is recommended, but it has not been clearly described. An understanding of the experience of caregivers is needed to improve the support provided to them by healthcare professionals. DESIGN: A qualitative, interpretative, phenomenological approach was used. METHODS: Twelve informal caregivers participated in qualitative interviews. The analysis followed the six steps of the interpretative phenomenological approach. RESULTS: Caregivers' experiences were described using five themes: (1) feeling overwhelmed by their loved one having unexplainable symptoms and behaviours; (2) learning that this and previous experiences were complications of liver disease; (3) becoming aware of the symptoms of hepatic encephalopathy; (4) having feelings of being tied down and (5) experiencing and overcoming obstacles in working with healthcare professionals. CONCLUSIONS: This study provides insight into caregivers' experiences and the consequences for their lives. The first occurrence of symptoms was a shock, but receiving the diagnosis was seen as an important step in understanding and learning. Caregivers provide daily assessments of their relatives' conditions, and they feel responsible for medication management. Over time, the caregivers impressively showed how they were able to incorporate their personal experiences into caregiving and to accept more accountability in managing the disease. RELEVANCE TO CLINICAL PRACTICE: Nurses should acknowledge caregivers as experts in caring for their loved ones. Nurses can assist caregivers in managing an episode of hepatic encephalopathy and can provide individualised interventions to ease the future burden.

Older persons' and their families' experience with live-in foreign home care workers. A grounded theory study / Erfahrungen von älteren Menschen und deren Familien mit einer Rund-um-die-Uhr Betreuung durch Care MigrantInnen. Eine Grounded Theory Studie

Background: Live-in arrangements with migrant care workers have considerably increased over the last years since they allow older frail persons to age-in-place despite functional limitations. However, little is known about the ramifications live-in care arrangements for families. Aim: The aim of the study was to investigate families' experience with live-in migrant care workers and indicators of quality from their perspective. Method: Constructivist grounded theory study with 22 families who were recruited via care agencies in the German-speaking part of Switzerland and participated in 29 individual or dyadic interviews. Results: Live-in care by migrant care workers has potentially positive ramifications for older persons and their families, but only so if families, first, reach a consensus about the need for the employment of migrant care workers; second, experience them as competent; and third, mutually forge relationships and negotiate daily life. A successful care arrangement occurs when there is a relational fit among those involved, which leaves families feeling cared for, safe and relieved. They experience a renewed stability in their family system, enriching relationships, and assuredness about the quality present in the care situation. Conclusions: A successful care arrangement is the result of relationships that have been actively created and a negotiated shared existence in a family-like network. It has a positive effect on the well-being of those receiving care and their family members. The family-like network needs competent support.

Including nurses in care models for older people with mild to moderate depression: an integrative review.

AIMS AND OBJECTIVES: The aim of this integrative literature review was twofold: (1) to investigate different collaborative programmes for older people with depression living at home with diverse access to care and (2) to describe conceptualisation of the nurses' role and interventions within these care models. BACKGROUND: One in four older people who visits a General Practitioner suffers from depression. Depression is a concern for 15% of all older home-care service clients. Detecting and managing depression in older people is highlighted as a key role of nurses. A literature review has been conducted to investigate collaborative models of care, aimed at ensuring low-threshold access to care and exploring the scope of nurse practice within these models. METHODS: Literature review comprising 14 studies and reviews. RESULTS: Three different collaborative care programmes (Collaborative Care Model, Community Mental Health Team and Psychogeriatric Assessment and Treatment in City Housing programme) were identified. In all programmes, the essential aspects were complex and multifaceted interventions, provided by a variety of healthcare professionals, but the access to care differed. All studies described the role of nurses differently and with wide variations. CONCLUSIONS: Despite a broad scope of practice, nurses play a pivotal role within the different models of care. Nurses have to have the educational background and expertise in mental health issues to recognise depression and eventually be able to provide more comprehensive interventions to alleviate depression in older people. RELEVANCE TO PRACTICE: Collaboration is needed to meet the needs of older people with depression. New forms of work divisions are pivotal to achieve this objective.

[Is it beneficial to involve family member? A literature review to psychosocial interventions in family-centered nursing]. / Ist es hilfreich, Famiilienmitglieder einzubeziehen? Eine Literaturübersicht zu psychosozialen Interventionen in der familienzentrierten Pflege.

BACKGROUND: Families influence the wellbeing of patients and are influenced by illness themselves. Involving caregivers in patient care was examined in multiple studies. AIM: The aim of this literature review was to investigate the different approaches to family-centered interventions (FI) and to evaluate the tested outcomes as well as the detected effect sizes. METHODS: This search for a systematic literature review of randomized controlled trials and metaanalyses revealed three Meta Analyses with studies until 2007 and six randomized controlled studies from 2007 to 2012. RESULTS: FI showed small to middle positive effects on the outcomes depression, mental health, anxiety of patients and family members and on caregiver burden. A conclusive effect on physical health could not be shown. The results strongly depend on the enrolled patient population, the targeted participants of FI, as well as the focus, type and dose of FI. The studies showed vast differences in the length and type of intervention, the target population and the selection of outcomes. Comparing outcomes was difficult due to the use of different outcome measures. CONCLUSION: Further research with various populations, different FI intensity but with same, valid outcome measures is needed.

[Development of a nurse-led family counseling program for families of the elderly: the first cycle of a Community-Based Action Research Project (CBPR)]. / Entwicklung einer pflegegeleiteten Familienberatung für Familien älterer Menschen: Der erste Zyklus eines gemeindebasierten Aktionsforschungsprojektes (CBPR).

BACKGROUND: With the support of family members many elderly people can live an independent life at home. Accepting support respectively providing support might be a challenge for both elder and family member. Families often have little professional support to manage those challenges. AIM: Therefore, a nurse-led counseling program for families of the elders has been established. METHOD: The counseling program was developed with community-based participatory research (CBPR) methodology using individual and focus group interviews, as well as a written survey and tested in a pilot study. RESULTS: Managing disease in everyday life, helpful means of support at home, changes in family relations, information about services as well as information how to navigate the healthcare system have been themes to discuss in the counseling sessions. Participants in the pilot study showed a statistically not significant increase in well-being, and preparedness for care and were highly satisfied with the counseling program. CONCLUSIONS: Families of the elderly could actively participate in developing and researching a nurse-led family counseling program. Several family members still engage as co-researcher in the program and participate to improve the new service.

[How parents of adults persons with epilepsy do their best]. / Wie eltern erwachsener menschen mit epilepsie das beste aus ihrer situation machen--eine qualitative studie.

Epilepsy is a common and chronic disease which affects persons at every age. Even though medication can prevent seizures, epilepsy has implications for daily living. Sorrows, increased depression rates and restrictions in everyday life were documented among family caregivers of adult persons with epilpesy. To date, no study investigated how parents adapt to the epilepsy of adult children over time. The aim of this study was to explore experiences of parents of adult patients with epilepsy. Applying an interpretative phenomenological approach, narrative interviews with parents were reviewed to investigate parents' experiences. All parents described how they did their best to live with their situation. However, parents' experiences were distinctive and can be described as: "Being on the way together", "walking on a thightrope" and "struggling and caring all along". Using paradigm cases to describe what the epilepsy of their adult children ment to parents allowed to consider the context of these parents' experiences and enhanced understanding. As parents continue to support their adult children with epilepsy they should be included in specialist counselling and involved in care planning of their adult children.

Exploring Factors Associated With Family Caregivers' Preparedness to Care for an Older Family Member Together With Home Care Nurses: An Analysis in a Swiss Urban Area.

INTRODUCTION: Home-dwelling older people with chronic diseases often need the support of informal and formal caregivers in order to continue living at home. Family members, however, need to be willing and prepared for caregiving together with home care nurses. OBJECTIVES: The purpose of this study was to explore factors associated with family caregivers' preparedness to care for older home-dwelling adults who also receive home care nursing services. METHODS: For this cross-sectional correlational study, a structured questionnaire was sent to family caregivers of adults aged 65 years or older receiving services from a community care agency. A total of 243 participants returned the questionnaire, of which 199 could be analyzed. RESULTS: The stepwise backward regression model explained 29.1% of the variance of family caregivers' preparedness. Mutuality was the most strongly associated factor with family caregivers' preparedness whereas professional involvement of family caregiver in care process was important as well. Care intensity showed no significant impact. CONCLUSION: Nurses should support the whole family emotionally, and appreciate, admire, reinforce, and respect the caregivers' situation. Home care nurses need to invest in helping families to find solutions, to strengthen their relationships between family members and the older person dwelling at home.