Caregiving intensity and duration, cardiovascular disease, and race/ethnicity in family caregivers of persons with dementia.

We investigated if caregiving intensity and duration affected cardiovascular disease (CVD) risks and diagnosis and whether the relationship differed by race and ethnicity in family caregivers (FCGs) of persons with dementia. We conducted a secondary analysis of the 2015-2020 CDC Behavioral Risk Factor Surveillance System data using a logistic regression analysis. A total of 6132 dementia FCGs were included. We found that the more time FCGs spent providing care per week (intensity) or over time (duration), the more likely they reported CVD risks and diagnosis. However, the associations between caregiving intensity and CVD risks and diagnosis did not differ by race and ethnicity, nor did the associations between caregiving duration and the outcomes. These findings suggest future studies should be conducted to develop preventive strategies for FCGs' cardiovascular health. Further work is needed to identify the impact of race and ethnicity on the relationship between caregiving conditions and CVD with larger samples of racial and ethnic minorities.

Experiences of Older Family Care Partners of Persons With Heart Failure 1 Year After the Onset of the COVID-19 Pandemic: A Qualitative Study.

The coronavirus disease 2019 (COVID-19) pandemic has negatively affected the health and well-being of family care partners of older adults with heart failure (HF-FCPs). The purpose of the current study was to examine the caregiving experiences and coping strategies of older HF-FCPs during the ongoing pandemic. Qualitative telephone interviews were conducted with 13 HF-FCPs (aged ≥65 years) from January to April 2021. Three themes emerged: (1) Impact on Physical, Mental, and Social Health; (2) Limitations of Using Health Care Services; and (3) Coping Strategies. During the pandemic, HF-FCPs had increased caregiving burden due to managing their own age-related health and providing care to their family member with heart failure. After 1 year of COVID-19, they adjusted by increasing use of telecommunication platforms and following prevention and protection strategies. During the ongoing pandemic, emotional and social support, respite care, and digital health support for older HF-FCPs would be beneficial for improving their physical, mental, and social health. [Journal of Gerontological Nursing, 48(10), 47-52.].

Caregiving experiences of older family caregivers of persons with heart failure: A mixed methods study.

Older family caregivers of persons with heart failure (HF-FCGs) are an understudied and vulnerable population, who are at heightened risk for age-related physical and cognitive declines. We explored caregiving experiences of older HF-FCGs and examined levels of their caregiver burden, psychological distress, caregiving self-efficacy and quality of life (QoL) using descriptive mixed methods. We conducted telephone-based surveys and semi-structured interviews (N=13). Low levels of caregiver burden, psychological distress, and high levels of caregiving self-efficacy and QoL were reported. Through qualitative interviews, three qualitative themes emerged: (1) Impact of Being a Caregiver, (2) Managing Caregiver Distress, and (3) Embracing the Caregiver Role. Psychological distress was the most frequently reported. Physical, psychological, and social distress experienced by older HF-FCGs might be offset by their coping strategies and willingness to accept their caregiver role. FCG-centered support programs that help older HF-FCGs develop and apply their own coping strategies should be considered.

Eliciting the educational needs and priorities of home care workers on end-of-life care for patients with heart failure using nominal group technique.

BACKGROUND: Home care workers, as paid caregivers, assist with many aspects of home-based heart failure care. However, most home care workers do not receive systematic training on end-of-life care for heart failure patients. AIM: To elicit the educational needs and priorities of home care workers caring for community- dwelling adults with heart failure at the end-of-life. DESIGN: Nominal group technique involving a semi-quantitative structured group process and point rating system was used to designate the importance of priorities elicited from home care workers. Individual responses to the question, "If you have ever cared for a heart failure patient who was dying (or receiving end-of-life care on hospice), what are some of the challenges you faced?", were aggregated into categories using directed content analysis methods. SETTING/PARTICIPANTS: Forty-one home care workers were recruited from a non-profit training and education organization in New York City. RESULTS: Individual responses to the question were aggregated into five categories: (1) how to cope and grieve; (2) assisting patients with behavior changes, (3) supporting patients to improve their quality of life, (4) assisting patients with physical symptom management, and (5) symptom recognition and assessment. CONCLUSIONS: Our findings confirm the need for the formal development and evaluation of an educational program for home care workers to improve the care of heart failure patients at the end-of-life. There is also a need for research on integrating home care workers into the interprofessional healthcare team to support optimal health outcomes for patients with heart failure.

Effects of Physical Activity Programs on Health Outcomes of Family Caregivers of Older Adults with Chronic Diseases: A Systematic Review.

This systematic review was conducted to analyze and capture the most recent trends in physical activity interventions for family caregivers of older adults with chronic disease as found in randomized clinical trials over the last 10 years (2010-2020). We used PubMed, CINAHL, Embase, PsycInfo, and the Cochrane Library. We synthesized participants' demographics, physical activity interventions and family caregivers' health outcomes. The Cochrane Collaboration Risk of Bias Tool was used to assess risk of bias of the included studies. Sixteen studies were included and most studies (n = 11) had a moderate risk of bias. Physical activity programs with mixed modes (e.g., aerobic and resistance exercise), mixed delivery methods (e.g., in-person and telephone) and mixed settings (e.g., supervised gym-based sessions and unsupervised home-based sessions) were used most frequently. Physical activity interventions significantly improved psychological health but had inconsistent effects on physical health. This review provides current trends and research findings that suggest types of physical activity interventions and components that improve family caregivers' health and wellness.

Factors Related to Biological Sex Differences in Engagement with Healthcare Providers in Persons Living with HIV.

Little is known about how engagement with healthcare providers mediates the relationship between psychosocial factors (anxiety, depression, stigma) and medication adherence among persons living with HIV (PLWH). Moreover, little research has investigated potential biological sex differences in this relationship. We conducted a secondary analysis of data collected from four projects (N = 281) focused on improving health outcomes in PLWH. Males displayed (a) negative association between depression and engagement with healthcare providers (ß = - 0.02, z = - 3.20, p = 0.001) and (b) positive association between engagement with healthcare providers and medication adherence (ß = 0.55, OR = 1.73, z = 2.62, p = 0.009). Females showed no association between any of these factors. Anxiety and stigma were not significantly associated with medication adherence. Path analysis modeling for males had a very good fit (CFI = 1, TLI = 1, RMSEA = 0); none of the regression coefficients was significant for females. The significant relationship between depression and medication adherence among males was fully mediated by engagement with healthcare providers. Findings suggest that adherence interventions for PLWH should be tailored by biological sex.

Building trust and facilitating goals of care conversations: A qualitative study in people with heart failure receiving home hospice care.

BACKGROUND: Despite a majority of persons receiving hospice care in their homes, there are gaps in understanding how to facilitate goals of care conversations between persons with heart failure and healthcare providers. AIM: To identify barriers and facilitators which shape goals of care conversations for persons with heart failure in the context of home hospice. DESIGN: A qualitative descriptive study design was used with semi-structured interviews. SETTING/PARTICIPANTS: We conducted qualitative interviews with persons with heart failure, family caregivers, and interprofessional healthcare team members at a large not-for-profit hospice agency in New York City between March 2018 and February 2019. RESULTS: A total of 39 qualitative interviews were conducted, including with healthcare team members (e.g. nurses, physicians, social workers, spiritual counselors), persons with heart failure, and family caregivers. Three themes emerged from the qualitative interviews regarding facilitators and barriers in goals of care conversations for better decision-making: (1) trust is key to building and maintaining goals of care conversations; (2) lack of understanding and acceptance of hospice inhibits goals of care conversations; and (3) family support and engagement promote goals of care conversations. CONCLUSION: Findings from this study suggest that interventions designed to improve goals of care conversations in the home hospice setting should focus on promoting understanding and acceptance of hospice, family support and engagement, and building trusting relationships with interprofessional healthcare teams.

Clinical nurses' experiences and perceptions after the implementation of an interprofessional team intervention: A qualitative study.

AIMS AND OBJECTIVES: To explore clinical nurses' experiences and perceptions following a purposeful interprofessional (IP) team intervention in practice. BACKGROUND: Despite increasing interest in IP collaborative practice to improve teamwork, nursing outcomes and quality of care, there has been little research that focused on nurses' perspectives of IP collaboration after a purposeful IP team intervention. DESIGN: A qualitative descriptive study using focus group interviews of registered nurses who care for patients with advanced heart failure. METHODS: This study is part of a larger study that conducted and evaluated a purposeful IP team intervention. Registered nurses (n = 10) were invited to participate in three focus groups following the IP team intervention. Data were audio-recorded, transcribed and analysed using a conventional content analysis approach and constant comparative method. RESULTS: We identified six interrelated themes: (a) IP team building, (b) psychological safety and cultural change, (c) efficiency in delivery of care, (d) quality of patient care, (e) job outcomes and (f) team challenges. Notably, participants reported that they could better understand the patient's care plan of the day because every team member was "on the same page at the same time." Registered nurses perceived that they were more satisfied with their job through improved IP team performance, enhanced psychological safety and cultural change, efficient workflow and better quality of patient care. CONCLUSIONS: The IP team intervention contributed to enhancing IP team functioning as well as improving registered nurse job satisfaction. To sustain the improved perceptional and behavioural changes, team strategies to improve workflow and communication should be considered. RELEVANCE TO CLINICAL PRACTICE: Effective teamwork and communication between multiple healthcare professionals including nurses are the cornerstones to improve care delivery, nursing outcomes and quality of patient care in clinical settings.

Purposeful interprofessional team intervention improves relational coordination among advanced heart failure care teams.

Effective delivery of healthcare is highly interdependent within and between interprofessional (IP) care teams and the patients they serve. This is particularly true for complex health conditions such as advanced heart failure (AHF). Our Academic Practice Partnership received funding to carry out IP workforce development with inpatient AHF care teams. Our objectives were to (a) identify challenges in team functioning that affected communication and relationships among the AHF care teams, (b) collaboratively identify a focal work process in need of improvement, and (c) test whether facilitated the implementation of team training and work process changes would lead to improvements in team communication, relationships, and process outcomes. The health-care team identified implementation of structured IP bedside rounds (SIBR) as the preferred approach to improving collaborative care. Utilizing a cross-sectional pre/post design, changes in team communication and relationships before and after a team intervention that included TeamSTEPPS training and SIBR implementation, were assessed using a validated Relational Coordination (RC) survey. The study population included AHF care team members (n ~ 100) representing seven workgroups (e.g., nurses, pharmacists) from two inpatient cardiology units at a 450-bed academic medical center in the Pacific Northwest during 2015-2016. Improvements in RC scores were demonstrated across all seven RC dimensions from baseline (Year 1) to follow-up (Year 2). Percent change on each of the seven dimensions ranged from 3.57% to 9.85%. Changes were statistically significant for improvements between baseline and follow-up on all but one of the seven RC dimensions (shared knowledge). The IP team intervention was associated with improvements in RC from baseline to follow-up. Additional research is needed to assess patient perspectives and outcomes of the IP team intervention. Findings of this study are consistent with the growing body of RC and SIBR research and provide a useful model of an IP team-based intervention in clinical practice.

Examining interprofessional team interventions designed to improve nursing and team outcomes in practice: a descriptive and methodological review.

Effective interprofessional (IP) team-based care is critical to enhance the delivery of efficient care and improve nursing and IP team outcomes. This study aims to review the most recent IP team intervention studies that focused on outcomes related to nursing and IP teams. PubMed, CINAHL, PsycINFO, and Embase were searched for existing literature published between January 2011 and December 2016. The search strategy was developed through both literature review and consultation with a health sciences librarian. This review included IP team intervention studies published in peer-reviewed journals and written in English. Studies were included if they conducted an IP team intervention for healthcare teams that include nurses and examined outcomes related to nursing and the IP teams. Based on inclusion and exclusion criteria, 41 articles were included for the final review. Two authors extracted data on the characteristics of IP team interventions, assessment methods, and their outcomes related to nursing and IP teams using a data abstraction tool developed by the research team. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. We found that most of the included studies were conducted in the US and on inpatient units. A quasi-experimental study design was most commonly employed. Most studies conducted IP team training such as TeamSTEPPS® as a one-time activity. The most common outcomes measured were attitudes or perceptions about IP teamwork or communication, followed by patient-related outcomes, and knowledge or skills about IP competencies. The quality of the included studies was generally low. The findings from this review will contribute to understanding the characteristics of current IP intervention studies and call for IP scholars to design more rigorous yet realistic IP intervention studies.

Assessing Racial and Ethnic Differences in Cardiovascular Disease in U.S. Family Caregivers of Persons With Dementia: Analysis of Data from the 2015-2020 Behavioral Risk Factor Surveillance System.

The current study examined racial and ethnic differences in psychological, behavioral, and metabolic risk factors for cardiovascular disease (CVD) and CVD conditions among family caregivers (FCGs) of persons with dementia. We used the 2015-2020 Behavioral Risk Factor Surveillance System data. The sample included a total of 6,132 FCGs of persons with dementia. Compared to non-Hispanic White FCGs, non-Hispanic Black and non-Hispanic Asian FCGs were less likely to have depression. The Other racial/ethnic FCG group was more likely to currently smoke. Non-Hispanic Black FCGs were less likely to have exercised, more likely to be obese, and more likely to have been diagnosed with diabetes. No differences in CVD conditions (e.g., angina/coronary heart disease, stroke, myocardial infarction) were detected between racial/ethnic minority FCGs and non-Hispanic White FCGs. Future studies should investigate relationships between racial/ethnic minority-specific caregiving and CVD by including a larger, racially and ethnically diverse population of FCGs. [Research in Gerontological Nursing, 16(5), 241-249.].

Heart Failure Family Caregivers' Perspectives of Physical Activity Engagement: A Qualitative Study.

Research on caregiver burden and related psychological distress has been widely studied. However, little research has focused on perspectives and experiences of older family caregivers of persons with heart failure on engaging in physical exercise to improve their health and wellness. We investigated barriers and facilitators influencing physical activity engagement for older family caregivers of persons with heart failure through a qualitative descriptive study design utilizing participant interviews. The social cognitive theory framework guided the thematic analysis. Identified themes and subthemes that emerged were centered around the framework's interrelated personal, environmental, and behavioral factors. Self-efficacy emerged as a central construct facilitating engagement in physical activity. The older family caregivers embraced technology for physical activity interventions more readily since the COVID-19 pandemic encouraged increased technology use. The age-related and caregiving barriers to physical activity found in this study highlight considerations for an older family caregiver and guide interventions for future family caregivers' engagement.

Perceptions and Attitudes toward a Proposed Digital Health Physical Activity Program among Older Family Caregivers of Persons with Heart Failure: A Qualitative Study.

Tailored physical activity (PA) programs using digital health technologies in the home can promote family caregivers' (FCGs) physical function and psychological wellbeing. However, there is a gap in research for digital health PA interventions targeting older FCGs of persons with HF (HF-FCGs). The burden of caregiving for persons with HF may displace the FCG's self-care, including PA. Therefore, we examined older HF-FCGs' perceptions and attitudes toward three technology components (video-conferencing, fitness tracker, text messaging) that would be most useful in delivering a digital health PA program. Interviews were conducted with 13 HF-FCGs (≥65 years old) between January and April 2021. Directed content analysis was used and the analysis was guided by the adapted unified theory of acceptance and use of technology (UTAUT) model. In addition to HF-FCGs' perceptions and attitudes toward each technology component in each construct of the adapted UTAUT model (ease of use, usefulness, facilitating conditions), three additional factors were associated with intention to use technology. These were: (1) HF patients' positive experience, (2) digital skills, and (3) quality of internet connectivity. The findings provide digital health requirements for design and modification of a technology-supported PA program that engages older FCGs who care for persons with HF.

Use of Digital Health Technology for Seeking Health Information Among Older Family Caregivers.

There is little research on the relationship between digital health technology use and health services, self-efficacy, health status, and health information seeking behavior among older family caregivers. We conducted a secondary analysis of the US Health Information National Data and found that older family caregivers with a regular healthcare provider are more likely to use digital health technology, which increases their confidence in obtaining health information (ß=0.075, z=2.015, p<0.044).

On Board: Interdisciplinary Team Member Perspectives of How Patients With Heart Failure and Their Families Navigate Hospice Care.

Hospice agencies serve an expanding population of patients with varying disease conditions and sociodemographic characteristics. Patients with heart failure represent a growing share of hospice deaths in the United States. However, limited research has explored the perspectives of hospice interdisciplinary team members regarding how patients with heart failure and their families navigate hospice care. We sought to address this research gap by conducting qualitative interviews with hospice interdisciplinary team members at a large, not-for-profit hospice agency in New York City (N = 32). Five overarching themes from these interviews were identified regarding components that members of the hospice interdisciplinary team perceived as helping patients with heart failure and their families navigate hospice care. These themes included (1) "looking out: caregiving support in hospice care," (2) "what it really means: patient knowledge and understanding of hospice," (3) "on board: acceptance of death and alignment with hospice goals," (4) "on the same page: communication with the hospice team," and (5) "like a good student: symptom management and risk reduction practices." Interdisciplinary team members delineated several components that influence how patients with heart failure and their families navigate hospice services and communicate with care providers. Hospice agencies should consider policies for augmenting services among patients with heart failure to improve their understanding of hospice, supplement available caregiving supports for patients without them, and remove communication barriers.

The Development and Implementation of a Cardiac Home Hospice Program: Results of a RE-AIM Analysis.

BACKGROUND: Use of hospice has grown among patients with heart failure; however, gaps remain in the ability of agencies to tailor services to meet their needs. AIM: This study describes the implementation of a cardiac home hospice program and insights for dissemination to other hospice programs. DESIGN: We conducted a multimethod analysis structured around the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework. SETTINGS/PARTICIPANTS: We used electronic medical records for our quantitative data source and interviews with hospice clinicians from a not-for-profit hospice agency (N = 32) for our qualitative data source. RESULTS: Reach-A total of 1273 participants were enrolled in the cardiac home hospice program, of which 57% were female and 42% were black or Hispanic with a mean age was 86 years. Effectiveness-The cardiac home hospice program increased hospice enrollment among patients with heart failure from 7.9% to 9.5% over 1 year (2016-2017). Adoption-Institutional factors that supported the program included the acute need to support medically complex patients at the end of life and an engaged clinical champion. Implementation-Program implementation was supported by interdisciplinary teams who engaged in care coordination. Maintenance-The program has been maintained for over 3 years. CONCLUSION: The cardiac home hospice program strengthened hospice clinicians' ability to confidently provide care for patients with heart failure, expanded awareness of their symptoms among clinicians, and was associated with increased enrollment of patients with heart failure over the study period. This RE-AIM evaluation provides lessons learned and strategies for future adoption, implementation, and maintenance of a cardiac home hospice program.

Visual analogies, not graphs, increase patients' comprehension of changes in their health status.

OBJECTIVES: Patients increasingly use patient-reported outcomes (PROs) to self-monitor their health status. Visualizing PROs longitudinally (over time) could help patients interpret and contextualize their PROs. The study sought to assess hospitalized patients' objective comprehension (primary outcome) of text-only, non-graph, and graph visualizations that display longitudinal PROs. MATERIALS AND METHODS: We conducted a clinical research study in 40 hospitalized patients comparing 4 visualization conditions: (1) text-only, (2) text plus visual analogy, (3) text plus number line, and (4) text plus line graph. Each participant viewed every condition, and we used counterbalancing (systematic randomization) to control for potential order effects. We assessed objective comprehension using the International Organization for Standardization protocol. Secondary outcomes included response times, preferences, risk perceptions, and behavioral intentions. RESULTS: Overall, 63% correctly comprehended the text-only condition and 60% comprehended the line graph condition, compared with 83% for the visual analogy and 70% for the number line (P = .05) conditions. Participants comprehended the visual analogy significantly better than the text-only (P = .02) and line graph (P = .02) conditions. Of participants who comprehended at least 1 condition, 14% preferred a condition that they did not comprehend. Low comprehension was associated with worse cognition (P < .001), lower education level (P = .02), and fewer financial resources (P = .03). CONCLUSIONS: The results support using visual analogies rather than text to display longitudinal PROs but caution against relying on graphs, which is consistent with the known high prevalence of inadequate graph literacy. The discrepancies between comprehension and preferences suggest factors other than comprehension influence preferences, and that future researchers should assess comprehension rather than preferences to guide presentation decisions.

Older Adults Can Successfully Monitor Symptoms Using an Inclusively Designed Mobile Application.

OBJECTIVES: Patient-Reported Outcomes Measurement Information System (PROMIS) measures can monitor patients with chronic illnesses outside of healthcare settings. Unfortunately, few applications that collect electronic PROMIS measures are designed using inclusive design principles that ensure wide accessibility and usability, thus limiting use by older adults with chronic illnesses. Our aim was to establish the feasibility of using an inclusively designed mobile application tailored to older adults to report PROMIS measures by examining (1) PROMIS scores collected with the application, (2) patient-reported usability of the application, and (3) differences in usability by age. DESIGN: Cross-sectional feasibility study. SETTING: Inpatient and outpatient cardiac units at an urban academic medical center. PARTICIPANTS: A total of 168 English- and Spanish-speaking older adults with heart failure. INTERVENTION: Participants used an inclusively designed mobile application to self-report PROMIS measures. MEASUREMENTS: Eleven PROMIS Short-Form questionnaires (Anxiety, Ability to Participate in Social Roles and Activities, Applied Cognition-Abilities, Depression, Emotional Distress-Anger, Fatigue, Global Mental Health, Global Physical Health; Pain Interference, Physical Function, Sleep Disturbance), and a validated health technology usability survey measuring Perceived Ease-of-Use and Usefulness of the application. RESULTS: Overall, 27% of participants were between 65 and 74 years of age, 10% were 75 years or older, 63% were male, 32% were white, and 96% had two or more medical conditions. There was no missing PROMIS data, and mean PROMIS scores showed the greatest burden of pain, fatigue, and physical function in the sample. Usability scores were high and not associated with age (Perceived Ease-of-Use P = .77; Perceived Usefulness P = .91). CONCLUSION: It is feasible for older adults to use an inclusively designed application to report complete PROMIS data with high perceived usability. To ensure data completeness and the opportunity to study multiple domains of physical, mental, and social health, future work should use inclusive design principles for applications collecting PROMIS measures among older adults. J Am Geriatr Soc 68:1313-1318, 2020.

RN Job Satisfaction and Retention After an Interprofessional Team Intervention.

Despite continuing interest in interprofessional teamwork to improve nurse outcomes and quality of care, there is little research that focuses on nurse job satisfaction and retention after an interprofessional team intervention. This study explored registered nurse (RN) job satisfaction and retention after a purposeful interprofessional team training and structured interprofessional bedside rounds were implemented. As part of a larger study, in this comparative cross-sectional study, pre- and post-intervention data on RN job satisfaction and turnover rate were collected and analyzed. It was found that RNs had significantly higher job satisfaction after the interprofessional team intervention. The 6-month period turnover rate in the post-intervention period was slightly lower than the 6-month period turnover rate in pre-intervention period; however, the rate was too low to provide statistical evidence. Ongoing coaching and supportive work environments to improve RN outcomes should be considered to enhance quality of care and patient safety in healthcare.

Informal Caregiver Decision-Making Factors Associated With Technology Adoption and Use in Home Healthcare: A Systematic Scoping Review.

Technology systems to alleviate the burden of caregiving are increasing in use. The home is a unique place where chronic disease management is often performed by informal caregivers, yet how caregivers make decisions about adopting a specific technology has not been thoroughly explored. This systematic scoping review mapped evidence on decision-making factors associated with technology adoption and use by caregivers of patients receiving care at home. We followed the recommendations developed by members of the Joanna Briggs Institute. Four electronic databases (PubMed, Medline, CINAHL, and Embase) were searched using both medical subject headings (MeSH terms) and key words. A total of six papers were included for data synthesis. Factors such as information, comprehension, motivation, time, perceived burden, and perceived caregiving competency were found to affect adoption of technology. There are other factors uniquely springing from the patient and technology, as well as shared issues between caregivers and patient, and caregivers and technology. Although some factors depend on technology type and patient diagnosis, there were some common factors across the research. Those factors can be carefully considered in referring technology use for caregivers. More focused study in this underinvestigated area is much needed.