Understanding family caregivers' needs to support relatives with advanced progressive disease at home: an ethnographic study in rural Portugal.

BACKGROUND: Family caregivers play an important role supporting their relatives with advanced progressive disease to live at home. There is limited research to understand family caregiver needs over time, particularly outside of high-income settings. The aim of this study was to explore family caregivers' experiences of caring for a relative living with advanced progressive disease at home, and their perceptions of met and unmet care needs over time. METHODS: An ethnographic study comprising observations and interviews. A purposive sample of 10 family caregivers and 10 relatives was recruited within a rural area in the north of Portugal. Data were collected between 2014 and 16 using serial participant observations (n = 33) and in-depth interviews (n = 11). Thematic content analysis was used to analyse the data. RESULTS: Five overarching themes were yielded: (1) provision of care towards independence and prevention of complications; (2) perceived and (3) unknown caregiver needs; (4) caregivers' physical and emotional impairments; and (5) balancing limited time. An imbalance towards any one of these aspects may lead to reduced capability and performance of the family caregiver, with increased risk of complications for their relative. However, with balance, family caregivers embraced their role over time. CONCLUSIONS: These findings enhance understanding around the needs of family caregivers, which are optimally met when professionals and family caregivers work together with a collaborative approach over time. Patients and their families should be seen as equal partners. Family-focused care would enhance nursing practice in this context and this research can inform nursing training and educational programs.

Collaborative care model versus usual care for the management of musculoskeletal and co-existing mental health conditions: a randomised feasibility mixed-methods study.

OBJECTIVE: This study aimed to assess the feasibility of a future trial comparing the collaborative care model with usual care for patients with musculoskeletal conditions and co-existing symptoms of anxiety and depression. DESIGN: A single-centre, parallel-arm, one-to-one, randomised controlled trial design using a mixed-methods approach was used. semistructured interviews and focus groups were conducted post intervention with all participants and staff respectively to explore acceptability towards the model and identify recommendations for improvements. SETTING: An orthopaedic rehabilitation outpatient tertiary hospital. PARTICIPANTS: Adult patients with musculoskeletal conditions and co-existing moderate or severe symptoms of anxiety and depression attending outpatient therapy appointments. INTERVENTION: The collaborative care model consisted of a tailored management programme to facilitate the integration of care provided by physical and mental healthcare professionals. A case manager screened and coordinated targeted mental health support for participants. Participants allocated to usual care had no support from the case manager. MAIN OUTCOMES MEASURE: Feasibility indicators (rates of recruitment, randomisation and retention), acceptability of clinical outcome measures, usage of additional resources and cost of intervention implementation. RESULTS: Of the 89 patients who provided consent to take part, 40 participants who matched the eligibility criteria were randomised to either the intervention (n=20) or usual care arm (n=20). Overall adherence to the intervention was 58.82%, while the withdrawal rate was 37.5% at 6 months. All of the 27 participants who were retained completed self-reported outcomes. Qualitative data highlighted that integrated mental health support was favourably perceived. In addition to prenegotiating protected psychology time, the need for operationalised communication between the case manager and clinicians was identified as a recommendation for a future trial. CONCLUSIONS: The trial and intervention were acceptable to patients and healthcare professionals. While the findings demonstrate the feasibility of trial recruitment, a future trial will require optimised retention strategies to improve adherence and withdrawal rates. TRIAL REGISTRATION NUMBER: NCT05018039.

The needs of informal caregivers of elderly people living at home: an integrative review.

BACKGROUND: Over the past years, researchers have developed studies about informal caregivers who care for the elderly living at home. Meeting these needs can help these professionals to provide more appropriate care. AIM: To explore and define the current status of published literature related to the needs of informal caregivers who care for the elderly living at home. METHOD: This study follows an integrative literature review using Whittemore and Knafl's method. Given the lack of higher-level evidence on this area of study, this method was considered to be the most appropriate to explore and define the current status of the available literature, which comes from a variety of scientific sources, and diverse methodologies. The literature research was performed using eleven electronic databases. The search was developed during the months of December 2010 and February 2011 and updated from March to April 2011. Studies written in English, Portuguese and Spanish were included. A total of 14 articles met the criteria in this review. Data were extracted from primary studies using quantitative, qualitative and mixed methods. RESULTS: The literature review showed a shortcoming of studies about the needs of caregivers of the elderly at home. It also identified a lack of high-quality scientific evidence in this area. From the literature available, four core themes were generated to reflect the literature: information and training, professional support, effective communication and legal and financial support. CONCLUSION: This integrative review offers important insight into the needs of informal caregivers, specifically for the elderly. The inclusive nature of integrative review method enabled us to provide a good understanding of underlying issues on the needs of informal caregivers. Challenges for the future are to broaden and enhance the scope of research in this area to provide effective support to intervention projects, services and care to informal caregivers.

Collaborative care model versus usual care for people with musculoskeletal conditions and co-existing anxiety and depression: protocol for a feasibility mixed-methods randomised controlled trial.

BACKGROUND: In the UK 17.8 million people have musculoskeletal pathophysiology, which becomes universal with age. Levels of discomfort and incapability correlate with symptoms of anxiety and depression. People with sufficient symptoms who seek care can benefit from collaborative diagnosis and treatment of mental and physical health organised by a case manager. This paper presents the protocol for a feasibility trial of collaborative care in an orthopaedic setting. AIMS: To determine the feasibility and acceptability of providing collaborative care for patients with musculoskeletal conditions and co-existing symptoms of anxiety and depression identified on a screening tool in a physical and occupational therapy out-patient setting. METHOD: A two-arm parallel-group randomised controlled trial will recruit 40 adult out-patients with at least moderate anxiety and depression, who have been referred for physiotherapy and occupational therapy. Participants will be allocated on a 1:1 ratio to collaborative care or to usual care. Co-primary outcomes will be key feasibility indicators collected at baseline and at 6 months. A qualitative study will be conducted post-intervention to explore the acceptability and potential improvements to the collaborative care model. RESULTS: This study will investigate the use of the collaborative care model for patients with musculoskeletal and co-existing moderate or severe levels of anxiety or depression. CONCLUSIONS: The results will provide important evidence to determine a future trial.

Os contributos dos sistemas de apoio à tomada de decisão para a prática de enfermagem / Contributions of the support systems decision making for nursing practice

Objectivos: Síntese interpretativa crítica com o objectivo de analisar e reflectir sobre os contributos dos sistemas de apoio à tomada de decisão para a Enfermagem. Métodos: Realizada uma revisão do período de Janeiro de 2004 e Junho de 2011, recorrendo à pesquisa em bases de dados electrónicas: B-On (Annual Reviews, Elsivier, SpringerLink, Wiley Online Library, Academic Search Complete, Pubmed, Web of Science e RCAAP), SCOPUS e EBSCO. Utilizou-se como descritores enfermagem, sistemas de apoio à tomada de decisão, com o carácter boleano "and". Resultados: Dos 15 artigos seleccionados, emergiram 4 categorias relacionadas com os Sistemas de Apoio à Tomada de Decisão para a prática de Enfermagem: segurança dos clientes; suporte aos enfermeiros; melhoria da qualidade dos cuidados e limitações dos sistemas de apoio à tomada de decisão. Conclusão: Os contributos dos sistemas de apoio à tomada de decisão para a prática de enfermagem que mais se destacam são: segurança dos clientes e suporte aos enfermeiros. Contudo ficam patentes algumas limitações como a ausência de inclusão de Conhecimento da disciplina de Enfermagem na construção destes sistemas e a dificuldade dos Enfermeiros na utilização dos mesmos.

Objective: Critical interpretative synthesis in order to analyze and reflect on the contributions of systems to support decision making for nursing. Methods: We carried out a review between the period January 2004 and June 2011 using the search in electronic databases : B-On (Annual Reviews, Elsivier, SpringerLink, Wiley Online Library, Academic Search Complete, PubMed, Web of Science and unless otherwise indicated), SCOPUS and EBSCO. It was used as descriptors nursing, systems to support decision making, with the character Boolean "and". Findings: Of the 15 articles selected, four categories emerged relating to the support systems for decision making Nursing practice: safety of customers, support for nurses, improving the quality of care and limitation of systems to support decision making. Conclusions: The contributions of systems to support decision making for nursing practice that stand out are: security and customer support to nurses. But patents are some limitation such as the lack of inclusion of knowledge of nursing discipline in building these systems and the difficulty of nurses in the use thereof.

Objetivos: Síntesis interpretativa crítica con el fin de analizar y reflexionar sobre las contribuciones de los sistemas de apoyo a la toma de decisiones para la enfermería. Métodos: Se llevó a cabo una revisión del período de enero de 2004 y junio de 2011 mediante la búsqueda en bases de bases de datos electrónicas: B-On (revisiones anuales, Elsivier, Springer, Wiley Online Library, Academic Search, PubMed, Web of Science, ya menos que se indique lo contrario), SCOPUS y EBSCO. Fue utilizado como descriptores de enfermería y sistema de soporte de decisiones, con el boolean carácter "and". Resultados: De los 15 artículos seleccionados, emergieron cuatro categorías relativas a los sistemas de apoyo a la toma de decisiones para la práctica de enfermería: la seguridad de los clientes; el apoyo a las enfermeras; la mejora de la calidad de la atención y las limitaciones de los sistemas de apoyo a la toma de decisiones. Conclusiones: Las contribuciones de los sistemas de apoyo a la toma de decisiones para la práctica de enfermería que se destacan son: la seguridad y la atención al cliente para las enfermeras. Pero las patentes son algunas limitaciones como la falta de inclusión de los conocimientos de la disciplina de enfermería en la construcción de estos sistemas y la dificultad de las enfermeras en el uso de los mismos.