Needs of family members caring for stroke survivors in china: A deductive qualitative content analysis study by using the caregiver task inventory-25.

BACKGROUND: In China, family caregivers are usually the main carers of relatives after stroke due to traditional Chinese culture and the limited development of the primary healthcare system. This responsibility often results in burdens and negative health outcomes. However, family caregivers seldom receive support. To improve informal care, as well as the health and well-being of family caregivers, it is important to identify their needs. OBJECTIVE: This study aimed to deductively explore the needs of family members caring for stroke survivors in China. METHODS: Twenty-six semi-structured interviews were performed with family caregivers of stroke survivors who were selected from one city and three communities by purposive sampling. A deductive qualitative content analysis method was performed by using the Caregiver Task Inventory-25 (CTI-25), an instrument measuring the needs of family caregivers, as a framework. RESULTS: All subscales, as well as all belonging items in the CTI-25, were identified in the present study, meaning that the family caregivers had needs related to learning to cope with new role, providing care according to care-receiver's needs, managing own emotional needs, appraising supportive resources, and balancing caregiving needs and one's own needs. Moreover, needs related to financial support, both direct and indirect, were identified but not part of the CTI-25. CONCLUSION: These findings identified that family caregivers of stroke survivors in China had various needs, which is important knowledge when assessing needs and improving health care for family caregivers. Cultural adjustments and modifications should be made if CTI-25 is used in mainland China. This study also indicated a comprehensive and holistic perspective (individual, community, and social level) when identifying, assessing needs or implementing interventions to support family caregivers.

Effectiveness of Enhanced External Counterpulsation Treatment on Symptom Burden, Medication Profile, Physical Capacity, Cardiac Anxiety, and Health-Related Quality of Life in Patients With Refractory Angina Pectoris.

BACKGROUND: Patients with refractory angina pectoris experience recurrent symptoms that limit their functional capacity, including psychological distress and impaired health-related quality of life (HRQoL), despite optimized medical therapy. Enhanced external counterpulsation (EECP) is an evidence-based alternative noninvasive treatment. Although physical well-being and mental well-being are equally important components of health, few studies have investigated the psychological effects of EECP in patients with refractory angina pectoris. OBJECTIVE: The aim of this study was to evaluate the effects of EECP treatment in patients with refractory angina pectoris regarding medication profile, physical capacity, cardiac anxiety, and HRQoL. METHODS: This quasi-experimental study with 1-group pretest-posttest design includes a 6-month follow-up of 50 patients (men, n = 37; mean age, 65.8 years) who had undergone 1 EECP course. The following pretreatment and posttreatment data were collected: medication use, 6-minute walk test results, functional class according to the Canadian Cardiovascular Society, and self-reported (ie, questionnaire data) cardiac anxiety and HRQoL. In addition, the questionnaires were also completed at a 6-month follow-up. RESULTS: After EECP treatment, patients used significantly less nitrates (P < .001), walking distance increased on average by 46 m (P < .001), and Canadian Cardiovascular Society class improved (P < .001). In addition, all but 1 subscale of cardiac anxiety and all HRQoL components improved significantly (P < .05). The positive effects for cardiac anxiety and HRQoL were maintained at the 6-month follow-up. CONCLUSIONS: Enhanced external counterpulsation treatment resulted in reduced symptom burden, improved physical capacity, and less cardiac anxiety, leading to increased physical activity and enhanced life satisfaction for patients with refractory angina pectoris. Enhanced external counterpulsation treatment should be considered to improve the life situation for these patients.

Establishing the Psychometric Properties of the Comprehensive Ethos Towards Wellness Questionnaire in a Norwegian Population.

AIM: to replicate and establish the psychometric properties of the 74-item comprehensive Ethos Towards Wellness Questionnaire in a healthy Norwegian population in terms of content and construct validity as well as homogeneity and stability reliability. METHOD: A questionnaire with a methodological and developmental design was sent on two occasions to 214 healthy middle-aged participants and processed in two phases. RESULTS: The three life context and the ethos indexes at ordinal scale level showed an overall satisfactory construct validity (communalities > 0.30, factor loadings > 0.30, and factor total variance > 50%). On two occasions 4 weeks apart, reliability in terms of homogeneity (Cronbach's α > .70) and stability (intraclass correlation coefficient > 0.70) were also considered satisfactory for the same four indexes. CONCLUSIONS: This newly developed and possibly only questionnaire that focuses on "grasping the big human picture," based on both philosophical reasoning and empirical recommendations of wellness, was found to be valid and reliable in the screening and follow-up of wellness and ethos in a healthy Norwegian population.

Weaning from mechanical ventilation: factors that influence intensive care nurses' decision-making.

AIM: The aim of the study was to describe the factors that influence intensive care nurses' decision-making when weaning patients from mechanical ventilation. BACKGROUND: Patients with failing vital function may require respiratory support. Weaning from mechanical ventilation is a process in which the intensive care nurse participates in both planning and implementation. DESIGN AND METHOD: A qualitative approach was used. The data were collected by means of semi-structured interviews with 22 intensive care nurses. The interviews were transcribed and analysed using qualitative content analysis. FINDINGS: One theme emerged: 'A complex nursing situation where the patient receives attention and which is influenced by the current care culture'. There was consensus that the overall assessment of the patient made by the intensive care nurse was the main factor that influenced the decision-making process. This assessment was a continuous process consisting of three factors: the patient's perspective as well as her/his physical and mental state. On the other hand, there was a lack of consensus about what other factors influenced the decision-making process. These factors included the care culture constituted by the characteristics of the team, the intensive care nurses' professional skills, personalities and ability to be present. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: The individual overall assessment of the patient enabled nursing care from a holistic perspective. Furthermore, the weaning process can be more effective and potential suffering reduced by creating awareness of the care culture's impact on the decision-making process.