Care for the Caregiver: Evaluation of Mind-Body Self-Care for Accelerated Nursing Students.

Stress affects the well-being of both nursing students and the individuals with whom they work. With the theory of cognitive appraisal as a framework for this study, it is proposed that mind-body self-care strategies promote stress management by stabilization of emotions. Outcomes will be a perception of less stress and more mindful engagement with the environment. Objective of the study was to describe an evaluation of student perceived stress and mindfulness to 1-hour per week of class time dedicated to mind-body self-care (yoga, mindful breathing, Reiki, and essential oil therapy). It was a quasi-experimental study; data collection took place at 4 time points. Participants were entry-level accelerated nursing students from 3 US universities: 50 in the treatment group, 64 in the comparison group. Data included health-promoting practices using Health-Promoting Promotion Lifestyle Profile II as a control variable, stress and mindfulness (Perceived Stress Scale [PSS] and Mindful Attention Awareness Scale [MAAS]), and demographic information; analysis using mixed-design repeated-measures analysis of variances. There was a statistically significant interaction between intervention and time on PSS scores, F(3, 264) = 3.95, P = .009, partial η(2) = 0.043, with PSS scores of the intervention group decreasing from baseline to T3 when intervention ended whereas PSS scores of the comparison group increased from baseline. The average scores on the MAAS did not differ significantly. Evaluation of an embedded mind-body self-care module in the first nursing course demonstrated promising improvements in stress management. The findings support the appropriateness of integrating mind-body self-care content into nursing curricula to enhance students' ability to regulate stress.

Qualitative analysis of a nurse's responses to stroke caregivers on a web-based supportive intervention.

BACKGROUND: Approximately 800 000 people experience a stroke every year; most are cared for by unpaid family members in home settings. Web-based interventions provide 24/7 access to education/support services and have been explored in the literature with family caregivers dealing with chronic conditions. Current research into nurses' web-based interactions with caregivers in these interventions is lacking. OBJECTIVE: The aim of this qualitative secondary data analysis was to examine a nurse specialist's responses and advice that she gave in a web-based supportive intervention for stroke family caregivers used in a randomized controlled trial for 1 year. METHODS: Using a qualitative research design, caregivers were recruited from rehabilitation facilities in Ohio and Michigan (n = 36). They accessed the intervention's email forum and discussion group facilitated by the nurse. These email message data were examined using rigorous content analysis. RESULTS: The caregivers were primarily white women caring for a spouse, with an average age of 54 years. From the 2148 email messages between the nurse and caregivers, five themes emerged and were drawn to Friedemann's Framework. These themes included: getting to know the situation (Friedemann's coherence and individuation), validating emotions (individuation), promoting self-care (individuation), assisting in role adaptation (system maintenance and individuation), and providing healthcare information (system maintenance and individuation). CONCLUSIONS: These caregivers of stroke survivors were asking for advice, seeking support, and looking for information from an advanced practice nurse. Nurses, and others, in supportive roles can use these findings to promote informed care and directed interventions for caregivers dealing with stroke and its outcomes.

Caregivers' incongruence: emotional strain in caring for persons with stroke.

PURPOSE: Guided by Friedemann's framework, the purpose of this study was to examine the dimensions of new family caregivers' emotional strain in caring for persons with stroke. METHOD: Seventy-three caregivers who were new to that role participated in an interview every 2 weeks for a year as part of a NIH project. Of these caregivers, 36 participants were randomly assigned and had access to a Web-based intervention and its e-mail discussion. In this secondary data analysis, 2,148 e-mail discussion messages plus 2,455 narrative interview entries were used to examine dimensions of caregivers' emotional strain. Rigorous content analysis was applied to these data. RESULTS: The majority of these caregivers were white women with an average of 55 years who cared for spouses. Three themes emerged from these data: (1) being worried, (2) running on empty, and (3) losing self. DISCUSSION: Caregivers worried about themselves and their care recipient, sharing feelings of being just "plain tired." The caregivers felt that their lives were lost to giving care. They described in detail the emotional strain that they felt, as they took on new roles in caring for the person with stroke. CONCLUSION: This study informs nurses about new family caregivers' emotional strain, or incongruence in Friedemann's terms, from their viewpoint and provides direction for supportive education interactions.

The effect of a Web-based stroke intervention on carers' well-being and survivors' use of healthcare services.

PURPOSE: We hypothesised that carers of stroke survivors who participate in the Web-based intervention, Caring approximately Web, would have higher well-being than non-Web users. We also postulated that those survivors whose carers participated in Caring approximately Web would use fewer healthcare services. METHOD: A randomised, two-group, repeated measures design was used. Subjects were recruited from four rehabilitation centres from which first-time stroke survivors were discharged to home in two Midwestern states. Of 144 carers screened, 103 carers of these survivors who were novice Internet users were assigned to a Web or non-Web user group. Seventy-three subjects completed the study. INTERVENTION: Caring approximately Web was a Web-based intervention of education and support provided to the Web user group for 1 year. A bi-monthly telephone survey collected data on all carers well-being (perceived depression, life satisfaction) and survivors healthcare service use (self-reported provider and emergency department visits, hospital re-admissions, nursing home placement). RESULTS: No statistical differences were found between the groups in carers well-being or in the number of provider visits for survivors. There were significant differences in emergency department visits (p = 0.001) and hospital re-admissions (p = 0.0005) related to the health of survivors. CONCLUSIONS: This Web-based intervention helped new carers make informed decisions about healthcare needs of stroke survivors, thus reducing service use.

Two sides to the caregiving story.

PURPOSE: This descriptive study examined problems and successes that a sample of 73 adult caregivers new to the role expressed in the first year of caring for stroke survivors. Data were collected from May 2002 to December 2005. METHOD: Bimonthly, trained telephone interviewers asked the participants open-ended questions to elicit their experience in caregiving. Guided by Friedemann's framework of systemic organization, we analyzed the data using Colaizzi's method of content analysis. RESULTS: There were 2,455 problems and 2,687 successes reported. Three themes emerged from the problems: being frustrated in day-to-day situations (system maintenance in Friedemann's terms), feeling inadequate and turning to others for help (coherence), and struggling and looking for "normal" in caring (system maintenance vs. change). Three themes were attributed to the successes: making it through and striving for independence (system maintenance), doing things together and seeing accomplishments in the other (coherence), and reaching a new sense of normal and finding balance in life (individuation and system maintenance). CONCLUSION: These findings provided an in-depth, theorybased description of the experience of being a new caregiver and can help explain how caring can be a difficult yet rewarding experience. Knowledge of the changes over time allows health care professionals to tailor their interventions, understanding, and support.

Internet-based support for rural caregivers of persons with stroke shows promise.

The purpose of this pilot study was to test the feasibility of providing Internet-based education and support intervention to caregivers living in rural settings, including caregivers' satisfaction with the intervention. A secondary aim was to explore their experience of caring. Nine adult caregivers of persons with stroke were enrolled in this descriptive study from rehabilitation centers in northwestern Ohio and southeastern Michigan. They were given access to the intervention, Caring-Web, for three months. Data were collected from participants' bimonthly interviews, as well as e-mail communications. Procedures were tested and found valid, and caregivers were willing and able to use Caring-Web. Using Friedemann's framework of systemic organization, a coding system was developed for analyzing the qualitative data on the experience of caring. Five main themes emerged from these data. These findings help expand knowledge about caregivers dealing with stroke.

Caregivers dealing with stroke pull together and feel connected.

Changes that can accompany stroke may create considerable stress for individuals caring for the affected person. This study explored the coping process for nine rural-dwelling caregivers of persons with stroke and the responses of these caregivers to a Web-based support program. The qualitative data management program QSR N 5 was used to analyze quotes from telephone interviews and computer entries. Stories of how caregivers came together and supported one another emerged from the data collected as part of a larger study that examined the experience of caring. Friedemann's framework of systemic organization guided data analysis and interpretation. Actions demonstrated by the caregivers illustrated the process of crisis resolution through family togetherness in which nurses were included. The findings of this study aided in understanding this process and gave direction for nurses working with such clients.

Teaching nurses to focus on the health needs of populations: a Master's Degree Program in Population Health Nursing.

Responding to the mandate to prepare nurses for practice in population-based healthcare, the faculty at Cleveland State University (CSU) developed a unique Master of Science in Nursing program to prepare Population Health Nurse Experts. The program prepares nurses to examine the health status of populations and to design, implement, and evaluate nursing interventions accounting for the varied factors impacting on the health of a defined group. The speciality of population health nursing is practiced by nurses who can use population sciences (epidemiology, demography, population projections, and population behavioral theories) along with post-baccalaureate nursing competencies to work with defined populations across care environments. The authors discuss a curriculum that prepares nurses for this emerging speciality.

In-home online support for caregivers of survivors of stroke: a feasibility study.

The primary aim of this feasibility study was to determine if caregivers (n = 5) were willing and able to use Caring-Web, a Web-based intervention for support, from their home Internet connection for 3 months. The caregivers' perceived health and satisfaction with caring, as well as the care recipients' use of healthcare services, were recorded. The experience of caring (problems and successes) was examined. Data were collected via weekly online surveys and e-mail discussions. Descriptive analyses revealed that the 3 caregivers who completed the study were satisfied with Caring-Web. Caregivers rated their health as average to excellent and their satisfaction with caring as good. Care recipients averaged 6 calls/visits to a medical office with one emergency room visit and subsequent hospitalization. Major problems for the caregivers included dealing with medical conditions about which they lacked knowledge. Content analysis of the e-mail discussions revealed that subjects sought information about medical conditions related to caring for the survivor of the stroke. Major successes for the caregivers involved communicating effectively with the care recipient and returning to everyday life with family and friends.