Feasibility of engaging caregivers in at-home surveillance of children with uncomplicated severe acute malnutrition.

Many factors can contribute to low coverage of treatment for severe acute malnutrition (SAM), and a limited number of health facilities and trained personnel can constrain the number of children that receive treatment. Alternative models of care that shift the responsibility for routine clinical and anthropometric surveillance from the health facility to the household could reduce the burden of care associated with frequent facility-based visits for both healthcare providers and caregivers. To assess the feasibility of shifting clinical surveillance to caregivers in the outpatient management of SAM, we conducted a pilot study to assess caregivers' understanding and retention of key concepts related to the surveillance of clinical danger signs and anthropometric measurement over a 28-day period. At the time of a child's admission to nutritional treatment, a study nurse provided a short training to groups of caregivers on two topics: (a) clinical danger signs in children with SAM that warrant facility-based care and (b) methods to measure and monitor their child's mid-upper arm circumference. Caregiver understanding was assessed using standardized questionnaires before training, immediately after training, and 28 days after training. Knowledge of most clinical danger signs (e.g., convulsions, edema, poor appetite, respiratory distress, and lethargy) was low (0-45%) before training but increased immediately after and was retained 28 days after training. Agreement between nurse-caregiver mid-upper arm circumference colour classifications was 77% (98/128) immediately after training and 80% after 28 days. These findings lend preliminary support to pursue further study of alternative models of care that allow for greater engagement of caregivers in the clinical and anthropometric surveillance of children with SAM.

Training opportunities and the increase in the number of nurses in home-visit nursing agencies in Japan: a panel data analysis.

BACKGROUND: A training opportunity in which ongoing education is encouraged is one of the determinants in recruiting and retaining nurses in home-visit nursing care agencies. We investigated the association between ensuring training opportunities through scheduled training programs and the change in the number of nurses in home-visit nursing agencies using nationwide panel data at the agency level. METHODS: We used nationwide registry panel data of home-visit nursing agencies from 2012 to 2015 in Japan. To investigate the association between planning training programs and the change in the number of nurses in the following year, we conducted fixed-effect panel data regression analysis. RESULTS: We identified 4760, 5160 and 5025 agencies in 2012, 2013, and 2014, respectively. Approximately 60-80% of the agencies planned training programs for all staff, both new and former, during the study period. The means and standard deviations of the percentage change in the number of full time equivalent (FTE) nurses in the following year were 4.2 (19.8), 5.7 (23.5), and 5.8 (25.1), respectively. Overall, we found no statistically significant association between scheduled training programs and the change in the number of FTE nurses in the following year. However, the associations varied by agency size. Results of analysis stratified by agency size suggested that the first and second quartile sized agencies (2.5-4.0 FTE nurses) with scheduled training programs for all employees were more likely to see a 9.0% (95% confidence interval [CI]: 4.5, 13.5) and 8.5% (95% CI: 2.4, 14.5) increase in the number of FTE nurses in the following year, respectively. Similarly, the first and second quartile sized agencies with scheduled training programs for new employees were more likely to see a 4.7% (95% CI: 2.1, 7.2) and 3.3% (95% CI: 0.4, 6.2) increase in the number of FTE nurses in the following year, respectively. CONCLUSIONS: Ensuring training opportunities through scheduled training programs for all staff, both new and former, in relatively small-sized home-visit nursing agencies might contribute to an increase in the number of nurses at each agency.

Dehospitalisation at a general hospital in Minas Gerais: challenges and prospects. / A desospitalização em um hospital público geral de Minas Gerais: desafios e possibilidades.

OBJECTIVE: To analyse the dehospitalisation process at a general public hospital in Minas Gerais, Brazil, from the perspective of managers, health workers, users and their families. METHODS: This is a qualitative, exploratory, descriptive study based on the principles of methodological and theoretical dialectics. The participants were 24 hospital health workers and 15 companions of users going through the process of dehospitalisation. Data were collected from April to June 2015 using semi-structured interviews and a field journal records and subsequently subjected to content analysis. RESULTS: Analysis of the empirical material led to the construction of the following categories: Dehospitalisation: viewpoint of the institution and Family organisation for the dehospitalisation process. CONCLUSION: The study reveals a deficiency in the implementation, systematisation, internal reorganisation and continuity of care after dehospitalisation. Current dehospitalisation strategies do not favour comprehensiveness and continuity of home care.

The impact of an educational intervention on home support workers' ability to detect early pressure ulcer damage.

OBJECTIVE: To investigate the impact of an educational intervention on home support workers' ability to detect early pressure ulcer damage. METHOD: A repeated measure design was employed to quantify the effectiveness of an educational intervention, consisting of one pre-test and two post-tests. RESULTS: Education was provided to home support workers and this was followed by an assessment of their ability to correctly classify 20 photographs detailing varying stages of skin damage severity. At the baseline (pre-education), 58% of the photographs were classified correctly. At post-test 1, 55% of the photographs were classified correctly. In post-test 2 this increased to 58%, achieving the original baseline scores. There was a moderate negative relationship between pre-training and post-test 2 scores (r=-0.44; n=27; p=0.02). CONCLUSIONS: The educational intervention has been shown not to have a statistically significantly positive effect on home support workers' ability to detect early pressure ulcer damage. The moderate negative relationship between pre-training and post-test 2 scores concur with the aforementioned qualitative findings, and similarly indicate behaviour associated with individuals experiencing difficulty comprehending new health terms.

The parental care partnership in the view of parents of children with special health needs. / A parceria de cuidados pelo olhar dos pais de crianças com necessidades especiais de saúde.

OBJECTIVE To understand how the care partnership was experienced by parents of children with special healthcare needs. METHOD Qualitative, descriptive and exploratory study, carried out from December 2013 to February 2014. The method used was the narrative. The population corresponded to parents of children admitted to a medical service of a Pediatric Hospital in Portugal. The sample consisted of 10 parents. The data collection included the sociodemographic characterization and the etnobiografic orientation interview. Once transcribed, the interviews yielded 10 narratives of partnership experiences between the parents and the nursing team. RESULTS It was noted, as partnership opportunities, the training of parents and the collaborative decision-making, established in a dynamic, unique and ongoing relational process. CONCLUSION The opportunities for partnership are key assumptions for the care delivery focusing on the child and on the parents as their resources.

Educational video as a healthcare education resource for people with colostomy and their families. / Vídeo educativo como recurso para educação em saúde a pessoas com colostomia e familiares.

OBJECTIVE: To know the perceptions of participants in a support group for people with colostomy on the use of video as a resource for health education. METHOD: Qualitative research with 16 participants in a support group for people with colostomy in Santa Maria, Rio Grande do Sul, Brazil. Data were collected in April and May of 2016, through a focus group, and subjected to the thematic analysis proposed by Minayo. RESULTS: The results led to three categories: care and self-care are learned alone: the lived reality; health education and learning through educational video: perceived opportunities; the singularities of the educational video from the viewpoint of people with colostomy and their families. CONCLUSION: The scarcity of guidelines retards independence and hinders autonomy in care and self-care. The audio-visual technology applied in this study complements the educational guidelines, and can enable changes and the opportunity to rethink pedagogical nursing practices.

Short-term and long-term effects of a psycho-educational group intervention for family caregivers in palliative home care - results from a randomized control trial.

BACKGROUND: Family caregivers in cancer and palliative care often face heavy responsibilities and feel insufficiently prepared for the situation as caregivers. This study evaluates short-term and long-term effects of a psycho-educational group intervention aiming to increase preparedness for family caregiving in specialized palliative home care. METHODS: The study design was a randomized control trial where family caregivers were allocated either to an intervention or control group. The intervention was delivered as a program including three sessions by health professionals (physician, nurse, and social worker/priest). Family caregivers from 10 specialized palliative home care settings were included. Questionnaires with validated instruments at baseline, upon completion, and 2 months following the intervention were used to measure effects of the intervention. The primary outcome was preparedness for caregiving in family caregivers. RESULTS: In total, 21 intervention programs were delivered, and 119 family caregivers completed all three measurements. The intervention group had significantly increased their preparedness for caregiving in both the short-term and long-term follow-up compared with the control group. The intervention group also reported significantly increased competence for caregiving in short-term but not long. No effects of the intervention were found on rewards for caregiving, caregiver burden, health, anxiety, or depression. CONCLUSIONS: The psycho-educational intervention has the potential to be used by health professionals to improve preparedness for caregiving among family caregivers in palliative care both in short and long terms. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

The Validity and Reliability of the Parent Fever Management Scale: A Study from Palestine.

Parental concern about childhood fever and consequent use of antipyretics is increasing. Little is known about childhood fever management among Arab parents. No scales to measure parents' fever management practices in Palestine are available. The aim of this study was to validate the Arabic version of the Parent Fever Management Scale (PFMS) using a sample of parents in Palestine. A standard "forward-backward" procedure was used to translate PFMS into Arabic language. It was then validated on a convenience sample of 402 parents between July and October 2012. Descriptive statistics were used, and instrument reliability was assessed for internal consistency using Cronbach's alpha coefficient. Validity was confirmed using convergent and known group validation. Applying the recommended scoring method, the median (interquartile range) score of the PFMS was 26 (23-30). Acceptable internal consistency was found (Cronbach's alpha = 0.733) and the test-retest reliability value was 0.92 (P < 0.001). The Chi squared (χ (2)) test showed a significant relationship between PFMS groups and frequent daily administration of antipyretic groups (χ (2) = 52.86; P < 0.001). The PFMS sensitivity and specificity were 77.67 and 57.75 %, respectively. The positive and negative predictive values were 67.89 and 32.11 %, respectively. The Arabic version of the PFMS is a reliable and valid measure and can be used as a useful tool for health professionals to identify parents' fever management practices. The Arabic version of the PFMS can be used to reduce unnecessary parental practices in fever management for a febrile child.

Learning to deal with crisis in the home: Part 2 - preparing preregistration students.

The global shift of health care is from acute services to community and primary care. Therefore, registrants must be prepared to work effectively within diverse settings. This article is the second in a series discussing the preparation of nurses for contemporary health-care challenges in the community. In it, we outline the design, implementation, and evaluation of simulated emergency scenarios within an honours degree-level, pre-registration nursing curriculum in Scotland. Over 3 years, 99 final-year students participated in interactive sessions focusing on recognition and management of the deteriorating patient and emergency care. Clinical scenarios were designed and delivered collaboratively with community practitioners. Debriefing challenged the students to reflect on learning and transferability of skills of clinical reasoning and care management to the community context. Students considered the scenarios to be realistic and perceived that their confidence had increased. Development of such simulation exercises is worthy of further debate in education and practice.

A randomized controlled trial of the effectiveness of a self-help psychoeducation programme on outcomes of outpatients with coronary heart disease: study protocol.

AIM: To develop and examine the effectiveness of a home-based self-help psychoeducation programme on health-related quality of life, stress level, anxiety and depression symptoms, self-efficacy, cardiac risk factors and health service use of outpatients with coronary heart disease. BACKGROUND: Hospital-based cardiac rehabilitation programmes have been shown to improve, effectively, the quality of life of patients with coronary heart disease. However, a majority of these patients do not participate in these programmes, while those who do enrol in these programmes fail to complete the programmes. DESIGN: Randomized controlled trial with repeated measures. METHODS: This study was approved and received the grant in July 2013. A convenience sample of 128 coronary heart disease outpatients will be recruited from a tertiary hospital in Singapore. Participants are randomly assigned to the 4-week experimental group and will participate in the programme or the control group who will not participate in the programme. The outcome measures include the: 12-item Short Form Health Survey, Perceived Stress Scale, Hospital Anxiety and Depression Scale and General Self-Efficacy Scale. Data will be collected at baseline, then 4 and 16 weeks from baseline. At the end, a process evaluation will be conducted to assess the acceptability, strengths and weaknesses of our programme based on the participants' perspectives. DISCUSSION: Our programme offers coronary heart disease patients an additional option to the existing cardiac rehabilitative services in Singapore hospitals. It aims to help them manage their disease effectively by reducing cardiac risk factors and improve their health-related quality of life and psychological well-being.

Patients' and family members' experiences of a psychoeducational family intervention after a first episode psychosis: a qualitative study.

The objective of this study is to explore patients' and family members' experiences of the different elements of a psychoeducational family intervention. A qualitative, explorative study was performed based on digitally recorded in-depth interviews with 12 patients and 14 family members. The interview data were transcribed in a slightly modified verbatim mode and analysed using systematic text condensation. Six themes that both patients and family members experienced as important in the family intervention were identified: alliance, support, anxiety and tension, knowledge and learning, time, and structure. A good relationship between the group leaders and participants was essential in preventing dropout. Meeting with other people in the same situation reduced feelings of shame and increased hope for the future. Hearing real life stories was experienced as being more important for gaining new knowledge about psychosis than lectures and workshops. However, many patients experienced anxiety and tension during the meetings. The group format could be demanding for patients immediately after a psychotic episode and for those still struggling with distressing psychotic symptoms. Group leaders need to recognise patients' levels of anxiety before, and during, the intervention, and consider the different needs of patients and family members in regards to when the intervention starts, the group format, and the patients' level of psychotic symptoms. The findings in the present study may help to tailor family work to better meet the needs of both patients and family members.

Compassion fatigue in adult daughter caregivers of a parent with dementia.

Adult daughters face distinct challenges caring for parents with dementia and may experience compassion fatigue: the combination of helplessness, hopelessness, an inability to be empathic, and a sense of isolation resulting from prolonged exposure to perceived suffering. Prior research on compassion fatigue has focused on professional healthcare providers and has overlooked filial caregivers. This study attempts to identify and explore risk factors for compassion fatigue in adult daughter caregivers and to substantiate further study of compassion fatigue in family caregivers. We used content analysis of baseline interviews with 12 adult daughter caregivers of a parent with dementia who participated in a randomized trial of homecare training. Four themes were identified in adult daughter caregiver interviews: (a) uncertainty; (b) doubt; (c) attachment; and (d) strain. Findings indicated adult daughter caregivers are at risk for compassion fatigue, supporting the need for a larger study exploring compassion fatigue in this population.

[Caregivers' needs concerning mobility support of a family member with terminal cancer - a narrative review]. / Bedürfnisse pflegender Angehöriger betreffend der Mobilität ihres krebskranken Familienmitgliedes am Lebensende: Ein narrativer Review.

BACKGROUND: Care for cancer patients is often provided by family caregivers. The terminal care period is usually associated with restricted mobility. AIM: The aim of this literature review is to analyse the needs of caregivers concerning mobility support and encouragement in everyday care of a cancer patient at the end of life. METHODS: Relevant articles were identified via electronic database searches in Cochrane, PubMed, PsychINFO, ERIC, and CINAHL. Studies examining needs concerning mobility support and encouragement for terminal cancer care provided by family caregivers at home, published in English or German, have been included. The methodological quality of the included studies was assessed by two authors. RESULTS: A total of eleven studies with various designs have been included. The results show a need for information, guidance and support regarding mobility in two areas: i) activities of daily living including personal hygiene and ii) usage of equipment including transport. CONCLUSION: The literature review indicates that practical needs of family caregivers concerning mobility support and encouragement have been assessed unsystematically and not yet adequately studied. This should be done in future studies, in order to implement well-defined interventions for teaching nursing skills subsequently.

[The role of family carers of people with dementia in the assessment of need on the example of the CarenapD study]. / Die Rolle pflegender Angehöriger von Menschen mit Demenz in der Bedarfsbestimmung am Beispiel der CarenapD-Studie.

Need driven dementia care at home requires the use of needs assessments like CarenapD. The CarenapD Manual states that the person with dementia (PwD) and caregivers (CA) should be included in the assessment process. In a pre-post study CarenapD has been applied in PwD (n = 55) and CA (n = 49) by professional staff (n = 15), CA were much more involved than PwD. Needs in PwD in T0 and T1 showed frequently functional needs(50 %), no need were frequently found in dementia-specific needs (42 %) and frequently unmet need was present in social needs (35 %). Burden-related needs in CA were reduced from T0 to T1 in daily difficulties (-14 %), support (-20 %) and breaks from caring (-9 %).This secondary analysis compares the need results of PwD and CA to discuss the unequal involvement of clients. In this secondary analysis needs data of PwD and CA is included. Need in PwD at T0 and T1 showed frequently met functional need (50 %), frequently no need in dementia specific needs (42 %) and high unmet need in social needs (35 %). Burden in CA could be reduced from T0 to T1 in Daily Difficulties (-14 %), Support (-20 %) and Breaks from Caring (9 %). Compared to the literature it is remarkable that a high rate in no need was found in dementia specific needs. Needs of CA show congruent results, it seems to have come to relief of burden in CA. Lack of knowledge and shame in CA as well as the continuous presence of both clients within the assessment process may have caused that dementia-specific needs were not enough addressed. PwD and CA should be actively involved in the assessment process and should contribute their individual point of view, as stated in the CarenapD Manual.

Reducing the psychological distress of family caregivers of home-based palliative care patients: short-term effects from a randomised controlled trial.

BACKGROUND: Palliative care is expected to incorporate comprehensive support for family caregivers given that many caregivers suffer psychological morbidity. However, systematically implemented evidence-based psychological support initiatives are lacking. AIM: The objective of this study was to prepare caregivers for the role of supporting a patient with advanced cancer receiving home-based palliative care by offering a one-to-one psycho-educational intervention. We hypothesised that primary family caregivers who participated in the intervention would report decreased psychological distress (primary outcome), fewer unmet needs and increased levels of perceived preparedness, competence and positive emotions. METHODS: A three-arm randomised controlled trial was conducted comparing two versions of the intervention (one face-to-face visit versus two visits) plus standard care to a control group (standard care) across four sites in Australia. RESULTS: A total of 298 participants were recruited; 148 were in the Control condition, 57 in Intervention 1 (one visit) and 93 in Intervention 2 (two visits). Relative to participants in the control group; the psychological well-being of participants in the intervention condition was improved by a small amount but non-significantly. No significant reduction in unmet needs or improvements in positive aspects of caregiving amongst the intervention group were identified. However, the intervention demonstrated significant improvements in participants' levels of preparedness and competence for Intervention 2. CONCLUSION/IMPLICATIONS: This research adds to accumulating body of evidence demonstrating that relatively short psycho-educational interventions can enable family caregivers to feel more prepared and competent in the role of supporting a dying relative. Further investigation is required to determine the longer term outcomes of such interventions.

Developing leadership capacity for guideline use: a pilot cluster randomized control trial.

SIGNIFICANCE: The importance of leadership to influence nurses' use of clinical guidelines has been well documented. However, little is known about how to develop and evaluate leadership interventions for guideline use. PURPOSE: The purpose of this study was to pilot a leadership intervention designed to influence nurses' use of guideline recommendations when caring for patients with diabetic foot ulcers in home care nursing. This paper reports on the feasibility of implementing the study protocol, the trial findings related to nursing process outcomes, and leadership behaviors. METHODS: A mixed methods pilot study was conducted with a post-only cluster randomized controlled trial and descriptive qualitative interviews. Four units were randomized to control or experimental groups. Clinical and management leadership teams participated in a 12-week leadership intervention (workshop, teleconferences). Participants received summarized chart audit data, identified goals for change, and created a team leadership action. Criteria to assess feasibility of the protocol included: design, intervention, measures, and data collection procedures. For the trial, chart audits compared differences in nursing process outcomes. PRIMARY OUTCOME: 8-item nursing assessments score. Secondary outcome: 5-item score of nursing care based on goals for change identified by intervention participants. Qualitative interviews described leadership behaviors that influenced guideline use. RESULTS: Conducting this pilot showed some aspects of the study protocol were feasible, while others require further development. Trial findings observed no significant difference in the primary outcome. A significant increase was observed in the 5-item score chosen by intervention participants (p = 0.02). In the experimental group more relations-oriented leadership behaviors, audit and feedback and reminders were described as leadership strategies. CONCLUSIONS: Findings suggest that a leadership intervention has the potential to influence nurses' use of guideline recommendations, but further work is required to refine the intervention and outcome measures. A taxonomy of leadership behaviors is proposed to inform future research.

["It's not the old life that we live anymore..."--counselling of relatives in nurse discharge planning]. / "Es ist nicht mehr das alte Leben, das wir führen "--Beratung von Angehörigen im pflegerischen Entlassungsmanagement.

In Germany, discharge planning has been a mandatory part of hospital care since 2012 to ensure continuity of care and to support patients and relatives while crossing the critical interface between hospital and home care. However, it remains unclear how the information and counselling of informal caregivers integrated into this process can be conceptualised. An explorative study using focus groups was carried out aiming at identifying the carers' views and experiences for a needs-based conceptualisation of the information and counselling in discharge planning. The results indicate when, according to the interviewees, information and counselling should be offered and the importance of trust within the consultation process which should reach beyond the hospital setting. In addition to illness- and care-related aspects as well as organisational and administrative issues, carers also expressed needs for support in emotional coping, problem solving, relief of burden and peer support in everyday life. Integrating carers in the conceptualisation of discharge planning will help to develop needs-based information and counselling services.

Pan-Britain, mixed-methods study of multidisciplinary teams teaching parents to manage children's long-term kidney conditions at home: study protocol.

BACKGROUND: Care of children and young people (children) with long-term kidney conditions is usually managed by multidisciplinary teams. Published guidance recommends that whenever possible children with long-term conditions remain at home, meaning parents may be responsible for performing the majority of clinical care-giving. Multidisciplinary team members, therefore, spend considerable time promoting parents' learning about care-delivery and monitoring care-giving. However, this parent-educative aspect of clinicians' role is rarely articulated in the literature so little evidence exists to inform professionals' parent-teaching interventions. METHODS/DESIGN: This ongoing study addresses this issue using a combination of quantitative and qualitative methods involving the twelve children's kidney units in England, Scotland and Wales. Phase I involves a survey of multidisciplinary team members' parent-teaching interventions using:i) A telephone-administered questionnaire to determine: the numbers of professionals from different disciplines in each team, the information/skills individual professionals relay to parents and the teaching strategies/interventions they use. Data will be managed using SPSS to produce descriptive statisticsii) Digitally-recorded, qualitative group or individual interviews with multidisciplinary team members to explore their accounts of the parent-teaching component of their role. Interviews will be transcribed anonymously and analysed using Framework Technique. Sampling criteria will be derived from analysis to identify one/two unit(s) for subsequent in-depth studyPhase II involves six prospective, ethnographic case-studies of professional-parent interactions during parent-teaching encounters. Parents of six children with a long-term kidney condition will be purposively sampled according to their child's age, diagnosis, ethnicity and the clinical care-giving required; snowball sampling will identify the professionals involved in each case-study. Participants will provide signed consent; data gathering will involve a combination of: minimally-obtrusive observations in the clinical setting and families' homes; de-briefing interviews with participants to obtain views on selected interactions; focussed 'verbatim' field-notes, and case-note reviews. Data gathering will focus on communication between parents and professionals as parents learn care-giving skills and knowledge. Interviews will be digitally recorded and transcribed anonymously. DISCUSSION: This study involves an iterative-inductive approach and will provide a unique, detailed insight into the social context in which professionals teach and parents learn; it will inform professionals' parent-educative roles, educational curricula, and health care policy.

Establishment of a family-centred care programme with follow-up home visits: implications for clinical care and economic characteristics.

BACKGROUND: Elternberatung Frühstart is a family-centred care programme for very preterm infants and seriously ill neonates and their parents. The uniqueness of this programme is in its consistency and continuity in parental counselling from pregnancy at risk to follow-up home visits. PATIENTS AND METHODS: Family-centred care is provided by specialised nurses, a social education worker, a case manager, a psychologist and neonatologists. They give support and information to parents and facilitate transition to home including co-ordination of health care services and support networks. The programme starts with information for parents at risk of preterm delivery to lessen their anxieties and worries. After birth, parental bonding is encouraged and parents are involved in daily care procedures. The following weeks focus on communication, information and education in order to enhance parental competence. Discharge planning and coordinated follow-up visits involve the family doctor and several members of the welfare and health care system. One of the key objectives is to prevent re-hospitalisation. Over a 4 year period 330 families participated. Funding is provided by: 1) the hospital, from admission to discharge equivalent to one full-time nursing staff, 2) charity donations for follow-up visits and 3) health care insurance for social medical aftercare (Bunter Kreis) following §43, 2 SGB V in severe cases. RESULTS: As a result of this programme, the median length of stay was reduced by 24 days; the number of patients that stayed longer than average were reduced by 64% in the group of patients born < 1 500 g. At the same time the patient throughput increased from 243 to 413. CONCLUSION: To conclude, a family-centred care programme with coordinated follow-up increases parental satisfaction, reduces the length of the hospital stay and is therefore profitable.

"Flying by the seat of our pants": what dementia family caregivers want in an advanced caregiver training program.

Although dementia caregiver stress and burden can be ameliorated with intervention, such interventions typically occur in specific caregiving contexts and at specific points in the progression of the dementing illness. We explored the ongoing learning needs and preferences of previously trained caregivers. Descriptive analysis of caregiver survey responses (N = 168) informed follow-up focus group interviews conducted with 26 family caregivers. Content analysis of focus group data showed that caregivers enjoyed the interactive problem-solving of the group related to preparing for the future, shaping the troubling behavior of the care recipient, reshaping the resource team, and caring for themselves. These findings support the need for advanced training as caregivers move through the trajectory of caring for persons with dementia.